Cholesterol medications known as fibrates are primarily effective in lowering triglycerides and, to a lesser extent, in increasing HDL cholesterol levels.
Gemfibrozil (Lopid®) is the fibrate most widely used in the United States. This drug can be effective for patients with high triglyceride levels; however, it is not effective in lowering LDL cholesterol. It is used in some patients with heart disease for whom a treatment goal is lowering triglycerides or raising HDL. One study found that patients with heart disease, somewhat elevated triglycerides, and low HDL who took fibrates had reduced risk for a heart attack.
These cholesterol drugs are usually given in two daily doses 30 minutes before the morning and evening meals. The reductions in triglycerides generally are in the range of 20 percent to 50 percent, with increases in HDL cholesterol of 10 percent to 15 percent.
Fibrates are generally well tolerated by most patients. Gastrointestinal complaints are the most common side effect with fibrates. Fibrates appear to increase the likelihood of developing cholesterol gallstones. Also, fibrates can increase the effect of drugs that thin the blood, and this should be monitored closely by your physician.
Statins are the most prescribed drugs for cholesterol treatment. The major effect of the statins is to lower LDL (bad cholesterol) levels. They lower LDL cholesterol more than other types of cholesterol medications. The large reductions in total cholesterol and LDL cholesterol produced by these cholesterol drugs are responsible for large reductions in heart attacks and heart disease-related deaths.
Statins inhibit an enzyme (HMG-CoA reductase) that controls the rate of cholesterol production in the body. These cholesterol drugs lower cholesterol by slowing down the production of cholesterol and by increasing the liver's ability to remove the LDL cholesterol already in the blood.
Studies examining the effect of statins have reported 20 percent to 60 percent lower LDL cholesterol levels in patients taking these cholesterol drugs. Statins also reduce elevated triglyceride levels and produce a modest increase in HDL cholesterol.
Statins are usually administered in a single dose per day. Some must be taken at bedtime, but others can be taken at any time.
The statins are well tolerated by most patients, and serious side effects are rare. The side effects of statins usually are mild to moderate in severity and generally go away as your body adjusts. A few patients will experience:
- Upset stomach
- Abdominal pain or cramps.
Rarely, a patient will develop abnormalities in blood tests of the liver. Another rare side effect of statins is muscle problems, the symptoms of which are muscle soreness, pain, and weakness. If you experience any of these symptoms, or if you have brown urine, contact your healthcare provider right away to get blood tests for possible muscle problems.
Statins used for lowering cholesterol include:
- Atorvastatin (Lipitor®) or combination medications that contain atorvastatin (Caduet®, Liptruzet™)
- Fluvastatin (Lescol®, Lescol® XL)
- Pitavastatin (Livalo®)
- Lovastatin (Altoprev®, Mevacor®) or combination medications that contain lovastatin (Advicor®)
- Pravastatin (Pravachol®)
- Rosuvastatin (Crestor®)
- Simvastatin (Zocor®) or combination medications that contain simvastatin (Juvisync®, Simcor®, Vytorin®).