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Cholesterol Drugs that Reduce the Risk of Heart Disease

Dec 1, 2010 | By Melissa Lingohr-Smith
Cholesterol Drugs that Reduce the Risk of Heart Disease
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Drugs that lower levels of cholesterol include the statins, fibrates, niacin, ezetimibe and bile acid sequestrants. They act by different mechanisms to reduce cholesterol levels and low density lipoproteins, or LDLs. They are often used in combination to more effectively improve lipid profiles. The statins are most effective in reducing total cholesterol and LDLs, and this drug class is associated with a significant decrease in heart disease risk. However, there is still a substantial heart disease risk in patients taking statins, and combination therapies are proving more effective in improving lipid profiles and reducing cardiovascular risk, according to an article in the June 2010 issue of "Nutrition, Metabol,ism and Cardiovascular Diseases."

Statins

Statins are a group of drugs that lower cholesterol levels and other circulating lipids by inhibiting the synthesis of cholesterol in the liver. An analysis of seven large clinical trials with over 50,000 participants published in the October 2010 issue of "Acta Neurologica Scandinavica" reports that intensive therapy with statins that reduced LDL levels below 2.1 mmol/l decreased the risk of heart attacks, coronary heart disease, cardiovascular disease and stroke. Another large review of more than 70 clinical trials published in the October 2010 issue of "QJM: Monthly Journal of the Association of Physicians" concludes that statin therapies reduce cardiovascular disease-related deaths by 27 percent, fatal heart attacks by 21 percent and nonfatal heart attacks by 45 percent.

Fibrates

Fibrates increase fat utilization in the liver and decrease the release of triglycerides into the bloodstream. Fibrates are less effective than statins in improving lipid profiles and decreasing the risk of heart disease. A review of 18 clinical trials published in the May 2010 issue of the "Lancet" concludes that fibrates reduce the risk of major cardiovascular disease events by 10 percent and heart attacks by 13 percent. This study notes that therapies with fibrates are generally more effective in people with high triglycerides and/or those that have a high risk for developing heart disease.

Niacin

Niacin is an essential water-soluble B vitamin. In addition to decreasing LDLs, niacin is very effective in increasing high-density lipoproteins, or HDLs, which are often called "good cholesterol." Niacin is often used in combination with statins. A review in the April 2010 issue of the "Mayo Clinic Proceedings" reports that niacin therapy lowers the risk of heart attacks by 27 percent.

Ezetimibe

Ezetimibe reduces the intestinal uptake of dietary cholesterol and is effective in lowering LDLs and increasing HDLs. The study in "Nutrition, Metabolism and Cardiovascular Diseases" reports that ezetimibe improved measurements of atherosclerosis in one trial, but in others it did not. More research is required to determine whether ezetimibe effectively and safely reduces the risk of cardiovascular and heart disease.

Bile Acid Sequestrants

Bile acids are made from cholesterol in the liver. Bile acid sequestrants reduce cholesterol levels by increasing the excretion of bile acids, thereby requiring more cholesterol to be used in their production in the liver. Bile acid sequestrants are older drugs used before statins to reduce cholesterol. An article in the November/December 2007 issue of the "American Journal of Therapeutics" does note that they reduced the risk of cardiovascular events on account of their cholesterol-lowering activities, but more recent studies comparing their efficacy to other cholesterol-lowering drugs have not been conducted.

References

Article reviewed by Elizabeth Last updated on: Dec 1, 2010

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