Cholesterol medication — what works and what to expect

High cholesterol doesn't always feel different, but it raises your risk for heart attacks and stroke. Want a straight answer on medicines? Here are the main options, what they do, and real-world tips so you stay safe and get results.

Common drug types and how much they lower LDL

Statins are the first choice. High-intensity statins (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) can cut LDL by about 50% or more. Moderate doses cut 30–50%. They work by blocking cholesterol production in the liver.

Ezetimibe lowers LDL by roughly 18–25% when added to a statin. It blocks cholesterol absorption in the gut and is a good add-on if statins alone aren’t enough.

PCSK9 inhibitors (evolocumab, alirocumab) are injections you give yourself every 2–4 weeks. They can cut LDL by 50–60% and are used when risk is high or other meds don’t work.

Bile acid sequestrants lower LDL by about 15–25% but can cause constipation and interfere with other drugs. Fibrates mainly target high triglycerides. Niacin can help but is less common now because of side effects and limited heart benefit.

Side effects, monitoring, and interactions

Muscle aches are the side effect people worry about most. If you get new or severe muscle pain, tell your doctor. They may check creatine kinase (CK) only if symptoms are bad. Mild soreness often improves after changing dose or switching statin.

Statins can affect the liver. Doctors usually check liver enzymes before you start and then only if symptoms or at higher doses. Check a lipid panel 4–12 weeks after starting or changing dose, then every 3–12 months depending on control.

Watch for drug interactions. Grapefruit juice raises levels of some statins (especially simvastatin and lovastatin). Certain antibiotics, antifungals, and HIV drugs can interact too. Always tell your clinician about all medicines and supplements you take.

Want to avoid medicine? Lifestyle changes matter. Losing 5–10% of body weight, cutting saturated fats, eating more fiber, and getting 150 minutes of activity a week all lower LDL and improve heart health. But if your 10-year risk is high, medication gives the biggest, fastest benefit.

Thinking about buying meds online? Use licensed pharmacies, require a prescription for prescription drugs, read reviews, and verify contact information. Avoid any seller that ships prescription drugs without a prescription or asks for unusual payment methods.

Questions to ask your doctor: What is my LDL target? Why this drug and dose? What side effects should I watch for? When will we check blood tests? Clear answers help you stick with treatment and stay safe.

Start with one clear goal: know your risk and set an LDL target with your clinician. From there, choose the right medicine and check in regularly. That simple plan prevents surprises and keeps your heart healthier.

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