Cholesterol is a type of waxy fat, or lipid that circulates in your blood and is important for several functions. The body uses cholesterol to make vitamin D, cell walls, tissues, hormones, and bile acids to digest fat as well as to protect nerve fibers. But if levels get too high, cholesterol can build up in the arteries and may lead to a variety of life-threatening diseases including atherosclerosis, heart attack, and stroke.

You can reduce your cholesterol level by eating healthy, not smoking, exercising regularly and losing weight if you are obese or overweight. However, if these do not work within six months to one year, your doctor may prescribe a cholesterol-reducing medication.

These medications work by lowering the “bad” cholesterol level or raising the amount of “good” cholesterol. The effects of medication can be maximized when combined with lifestyle changes.

Statins

Statins are considered a first-line treatment for anyone with high cholesterol. They are also helpful in preventing coronary artery disease in people at risk. Statins work by lowering the cholesterol level in the body and strengthening the lining of the blood vessels. Statins also have minimal side effects and interact negatively with only a few other medications.

Statins lower the amount of LDL, or bad cholesterol, produced by the body. They act on the liver by blocking the enzyme “HMG CoA reductase.” This enzyme is needed to make LDL cholesterol. Statins have also been shown to remove some cholesterol from the bloodstream.

Statins can take from four to six weeks to show results. Once they begin to work, they can reduce LDL cholesterol from 20 to 60 percent. Side effects of statins are usually minimal, and can include upset stomach, gas, constipation, abdominal pain or cramps, and mild muscle aches. More serious side effects, such as liver damage or muscle deterioration, are extremely rare.

Resins, also known as bile acid sequestrants, are another class of drugs used to manage blood cholesterol by reducing LDL. Resins attach themselves to bile acids, which are made using cholesterol, and force it to pass completely through the digestive system. This causes the body to use more cholesterol for bile acid production, which in turn lowers the cholesterol level.

However, resins can also prevent the body from absorbing certain vitamins as well as other medications. In fact, doctors recommend taking other medications at least an hour before taking a resin.

Because resins remain in the digestive system and are not absorbed by the body, they are usually safe for a wide range of people, including pregnant women. While other cholesterol drugs are typically taken in pill form, resins are often a powder that is mixed with water and taken orally. The most common side effect of resins is gastrointestinal discomfort.

Fibrates, also known as fibric acid derivatives, lower triglycerides in the body, which are believed to increase the risk of heart disease. They work on the liver to reduce production of triglycerides by 20 to 50 percent. They can also help speed the removal of cholesterol from the blood.  

Side effects of fibrates include nausea and upset stomach. Fibrates can also irritate the liver, an effect that, in some patients, can be serious enough to discontinue the drug. Your doctor may order periodic liver function tests to monitor the effects of the fibrates your liver.

Niacin, or nicotonic acid, is a form of vitamin B that helps extract energy from the food you eat. When taken in excess, niacin, like fibrates, lowers triglycerides and raises “good” cholesterol. It is not known exactly how niacin works, but experts believe that it affects the liver; reducing the amount of cholesterol the body produces.

Niacin is especially effective in patients with low HDL, or good cholesterol, and high triglycerides. The doses needed for treatment, however, are more than 100 times the recommended daily intake of niacin and can be poisonous. So niacin is taken only under a doctor’s close supervision.

Most side effects of niacin are minor.  They include intense face and neck flushing, itching, nausea, and bloating. One serious, but rare, side effect is gout, a type of arthritis that occurs when uric acid builds in the joints.  Physicians often recommend aspirin be taken shortly before the niacin to minimize these effects.

The newest drug available to treat cholesterol is ezetimibe. Ezetimibe works in the intestines, but is the only drug that blocks the absorption of cholesterol from the food a person eats. It does this by binding with the fats and animal cholesterol contained in food as it passes through the intestines.

Ezetemibe is often most effective when used with statins. The combination can lower cholesterol by up to 40 percent.