What are some of the main medical treatments for dyslipidemia?
First-line medical treatments for dyslipidemia include lifestyle-based interventions; nutrition, exercise, avoiding tobacco, and weight loss are important first considerations when discussing dyslipidemia treatment.[1]
Some of the following drugs and therapeutics may be recommended based on a patient's overall risk of cardiovascular disease and individual presentation:[1]
- Statins are very effective at reducing LDL-C, and have shown a reduction in cardiovascular events (i.e., heart attacks and strokes)[2]
- PCSK9 inhibitors have also shown these effects, but are more expensive, and have a smaller body of research[3]
- Ezetimibe may be useful in addition to a statin if further risk reduction is required [4]
- Fibrates are recommended for moderate and severe elevations of triglycerides (> 400 to 500 mg/dL)[5]
- Bile acid sequestrants, such as cholestyramine, may effectively lower LDL-C; however, they may raise triglycerides, there is sparse data for cardiovascular event reductions when used in conjunction with statins, and poor adherence has been noted[6]
- Folic acid may lower triglycerides and total cholesterol, and was found to increase HDL in a dose-response fashion[7]
- Niacin may cause robust improvements in HDL-C of 21%; however, there is mostly consistent evidence showing a lack of reduction in cardiovascular events or mortality[8][9][10]
- Bempedoic acid shows promise for further reducing LDL-C when patients are on a maximally tolerated dose of statins, while not worsening muscular adverse events typical of statins[11][12][13][14]