These include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).

Statins are safe and effective drugs that have become standard therapy for patients with elevated LDL-C levels or risk factors for heart attack or stroke. If you already have coronary heart disease or diabetes your doctor will recommend statin therapy.

**A reduction in coronary events, stroke and death from all causes has been demonstrated for individuals with and without clinically evident CHD and with or without elevated LDL-cholesterol concentrations.

Resins (bile acid sequestrants)

These include colesevelam (Lodalis®) and cholestyramine (Questran® and Colestid®).

Resins are used to lower LDL-C levels, often in combination therapy with other blood lipid medications. These medications are not absorbed and side effects are limited to occasional abdominal discomfort and bloating. The lower LDL-C by 15% to 20%.

Cholesterol absorption inhibitors

Ezetimibe (Ezetrol®) reduces cholesterol absorption in the intestine and lowers LDL-C by 15 to 20%. It is generally used in combination with a statin.

PCSK9 inhibitors

These include evolocumab (Repatha®) and alirocumab (Praluent®).

These are monoconal antibodies that bind to the PCSK9 protein and are administered by injection every 2 to 4 weeks and lower LDL-C by an additional 60%.

Inclisiran (Leqvio®) is an siRNA that works in the cytoplasm of the liver cells to prevent the synthesis of the PCSK9 protein. It is administered by a nurse, doctor or pharmacist every 6 months and lowers LDL by an additional 50%.

PCSK9 inhibitors are used in combination with statin and ezetimibe for patients with extremely high levels of LDL-C due to a mutation in the LDL receptor gene (familial hypercholesterolemia) or for patients with heart disease who cannot achieve adequate cholesterol control on maximally tolerated statin therapy.