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Low density lipoprotein cholesterol lowering with drugs other than statins and PCSK9 inhibitors

Robert S Rosenson, MD
John JP Kastelein, MD, PhD, FESC
Section Editor
Mason W Freeman, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Lipid (or lipoprotein) altering agents encompass several classes of drugs including statins, cholesterol absorbing inhibitors, fibric acid derivatives, bile acid sequestrants, PCSK9 inhibitors, nicotinic acid, and others. These drugs differ with respect to mechanism of action and to the degree and type of lipid altering.

Most patients for whom a prescription drug therapy is deemed advisable will have an elevation in their low density lipoprotein cholesterol (LDL-C) level and a statin is the established first line therapy. Other lipid lowering drugs are used to augment statin effects on LDL-C, substitute for statins when that class cannot be used, or to treat non-LDL-C disorders, primarily hypertriglyceridemia. The decision to use a non-statin drug can be influenced by clinical parameters other than the lipid values themselves.

The characteristics, efficacy, and safety of the lipid-lowering drugs other than the statins and PCSK9 inhibitors will be reviewed here. The efficacy of statins and PCSK9 inhibitors is discussed elsewhere. (See "Statins: Actions, side effects, and administration" and "PCSK9 inhibitors: Pharmacology, adverse effects, and use".)

Additionally, therapeutic decision making in patients with elevated lipid levels is discussed in detail separately:

(See "Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease".)

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Literature review current through: Dec 2017. | This topic last updated: Mar 20, 2017.
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