Management of high plasma cholesterol with prescription drugs is a multi-billion dollar a year industry. Three classes of drugs lower cholesterol: absorption blockers, synthesis inhibitors and niacin-based. Within each class more than one drug is available. Large clinical trials have shown that lowering cholesterol reduces risk of heart attacks and deaths from heart attacks.
History
In the mid-20th century research scientists made a connection between plasma cholesterol and risk of heart disease. The Framingham Heart Study, an excellent example of this type of research, began in 1948 and continues to this day. First attempts to apply this knowledge addressed lowering dietary cholesterol intake and introduction of cholesterol absorption blockers. Starting in 1987, the first of a family of cholesterol synthesis inhibitor drugs was approved by the U.S. Food and Drug Administration, or FDA. Niacin-based products were introduced, later, as were combinations. Drug names and U.S. approval dates are provided in the following sections.
Absorption Blockers
Questran, Prevalite and Locholest are brand names for cholestyramine, a resin that binds bile in the digestive tract. By doing so, reabsorption of the cholesterol-rich bile is reduced and plasma cholesterol is lowered. The product is a granular powder taken mixed with water or juice. FDA approval for cholestyramine occurred in 1958. Zetia achieves the same end result by inhibiting the intestinal cell receptors responsible for absorbing cholesterol. Zetia was approved in 2003.
Statins Inhibit Cholesterol Synthesis
The first synthesis inhibitor to be approved by the FDA was Mevacor, in 1987. Subsequently approved as drugs were Pravachol, 1996; Zocor, 1997; Lipitor, 1997; Baycol, 1997; Lescol, 2000; Crestor, 2003; and Livalo, 2009. Baycol was voluntarily discontinued by Bayer in 2001 due to a high incidence of serious side effects. All of the generic names end in "-statin." Patent protection has expired on the first three, which therefore are also available by generic name: lovastatin, pravastatin and simvastatin. All statin drugs require ongoing patient monitoring for potentially life-threatening side effects.
Niacin Products
Niacin, the vitamin, lowers plasma cholesterol when used in doses far in excess of the vitamin requirements. Niaspan and Niacor, respectively, are the brand names for extended release and immediate release niacin. Approvals took place in 1999 and 2000. The former is less prone to cause a "flush" reaction--a reddening of the face and neck accompanied by a sensation of heat and tingling.
Combinations
Advicor, approved 2001, combines Mevacor with Niaspan. Vytorin, approved 2004, combines Zetia with Zocor.These drugs could be prescribed separately. As combination products they improve compliance. The combinations are also patent protected beyond the dates when patents expire for the individual drugs.
Non-Drug Alternatives
Non-drug foods can be used alone to achieve a more modest cholesterol lowering than seen with drugs, or combined with drugs. The soluble fiber beta-glucan from whole oats or barley interferes with cholesterol absorption, as does psyllium, from wheat bran. Foods fortified with phytosterols and/or phytostanols also interfere with cholesterol absorption. Red yeast rice is not recommended as a non-prescription statin alternative. Product labels do not specify the statin content of this dietary supplement, and comparative tests have shown that some contain no functional ingredient content.
Drug names and introduction years added. For Baycol, I clarified that it was a voluntary recall rather than a withdrawal of FDA approval, and added the recall year.
