Prevalence of high cholesterol levels among adults in the US is relatively high – one out of every three adults in the US has high cholesterol levels. While this is further divided into sub categories such as very high cholesterol levels, high levels of cholesterol etc., all individuals are expected to take suitable remedial measures. For instance, individuals with relatively high levels of cholesterol are advised to bring in dietary and lifestyle modifications to rein in cholesterol levels. Individuals with very high levels of cholesterol require medical intervention comprising medications and lifestyle, dietary modifications. Ideally, individuals should choose the best cholesterol medication with least side effects as cholesterol medications are taken on a long-term basis.

Most individuals are aware of the need to control diet, with lesser saturated fat, sugar, the need to eliminate trans fat from diet and to introduce necessary workout/physical activities. However, many remain unaware of the different types of medications and the possible side effects that may be experienced as a result of long-term use of medication. Here is a detailed analysis of various types of medications in use for treating high cholesterol levels. This helps identify the best cholesterol medication with least side effects.

Purpose of medication for treating high cholesterol levels

To identify the best cholesterol medication with least side effects it is necessary to understand more about the role of medications used for treating cholesterol. Medications may either be single drug formulations or combination of different medications. Medications typically help reduce the levels of LDL (low-density lipoprotein) cholesterol, that is commonly known as bad cholesterol. When bad cholesterol levels increase beyond a point, the individual is exposed to risk of heart ailments. Additionally, the mechanism of action of medications used for treating cholesterol involves increasing HDL (high-density lipoprotein) cholesterol. Commonly known as good cholesterol, HDL is essential for preventing onset of heart disease. Finally, medications help reduce triglycerides in the blood, thereby reducing risk of heart disease. Commonly prescribed medications include the following :

Statin class of medications : The first in the list of best cholesterol medication with least side effects, statins are considered as relatively safe when compared to other medications for treating cholesterol. One of the most popular medications, statins are often the first medication of choice for treating cholesterol. Statins reduce LDL, triglycerides and contribute to an increase in HDL levels. The various types of statins include Simvastatin, Lovastatin, Atorvastatin, Pravastatin, Rosuvastatin, Fluvastatin, and Pitavastatin. Statins are regarded as a good and proven choice for reducing the risk of heart attacks. Commonly reported side effects of statins include possible complications in the intestines. In certain rare instances, individuals have reported issues in the liver. Other possible side effects of statin class of medications include inflammation of the muscles, and a spike in blood sugar levels.

Resultantly, individuals on the medication may also end up with type 2 diabetes, in a limited number of cases. In certain instances, individuals have reported loss of memory apart from confusion when on the medication. Similar to other medications, there is also the possibility of the medication interacting with other medications. It is necessary to inform treating specialists about other prescription medications and supplements being consumed.

Bile acid resin class of medications : Medications that work in the intestines are typically known as bile acid resin drugs. The mechanism of action of these medications involves actions in the intestines, where the drug attaches to bile secreted from the liver. By attaching to the bile, the medications prevent the bile from being absorbed by the blood. By controlling the absorption of bile into the blood, the medications reduce the cholesterol levels as bile is made up of cholesterol. Medications in this category include Colestipol, Cholestyramine and Colesevelam. One category of drug reduces LDL levels by inhibiting the absorption of cholesterol in the intestines. The drug, Ezetimibe, helps reduce the risk of heart attack in patients who have had earlier episodes of heart attack. The commonly reported side effects of bile acid resin medications include formation of gas in the stomach, constipation and possible upset stomach. Other side effects include pain in the abdomen, muscle pain, back pain, and diarrhea.

Protein inhibitor class of medications : Individuals who are unable to reduce cholesterol levels through statin medications and changes in lifestyle, are recommended protein inhibitors. Known as PCSK9 blockers, these medications work by helping the body to flush out LDL from the blood. This condition typically affects adults genetically. Known as heterozygous familial hypercholesterolemia, the inherited condition, causes the body to have limitations in controlling cholesterol. Additionally, this is also used for treating individuals with heart ailments, and individuals who do not find results with statin medications. Examples of this class of medications include Evolocumab and Alirocumab. Commonly reported side effects of the medications include inflammation, pain and itching sensations on the area of administering the injection. Additionally, individuals have also reported experiencing cold, flu, pain in the back and reactions in the skin as a result of the medications.

B-vitamin class of medications : Prescription medications include nicotinic acid to bring down LDL levels and increase HDL levels. The B-class of medications that include Niacon and Niacor, help reduce risk of heart disease when taken alongwith statin medications. Commonly reported side effects of the medication include headache, itching sensation, flushing in the body, and a tingling sensation.

Fibrate class of medications : This class of medications helps reduce triglycerides in the body and help increase HDL levels. This combination of reduction in triglycerides and an increase in HDL levels helps bring down risk of heart ailments and cholesterol levels. Examples of medications include Gemfibrozil and Fenofibrate. By virtue of the mechanism of action and the limited role of the medication, the side effects are relatively lesser.

ACL inhibitor class of medications : Abbreviation for ATP Citrate Lyase, ACL Inhibitors work by preventing the liver from processing cholesterol. This helps to reduce LDL levels, and is particularly beneficial for individuals diagnosed with atherosclerotic cardiovascular disease. Common examples include Bempedoic, with reported side effects including pain in the stomach or discomfort. Other side effects include muscle spasms, infection in the upper respiratory tract, and possible bronchitis. Individuals may also experience a spike in liver enzymes, apart from excessive uric acid levels in blood. Finally, individuals may also possibly end up with anemia as a result of the side effects of the medication.

PUFAs and Omega-3 fatty acids : In addition to the above, medications used for treating the condition include Omega-3 fatty acid esters, apart from PUFAs (polyunsaturated fats). Commonly known as fish oils, these products help to reduce triglycerides. While certain products are available as over the counter formulations, some are available as prescription only medications. The commonly available products in this category include omega-3 acid ethyl esters and icosapent ethyl. While the side effects associated with these OTC and prescription products are relatively lesser, a few side effects are possible. For instance, individuals may experience belching when taking these products. Additionally, individuals are known to experience manifestation of certain skin conditions such as itching or outbreak of rashes. Finally, there is also the possibility of individuals experiencing a fish like taste in the mouth all the time. In addition to the above, there is also the possibility of allergies that are attributed to fish oil and fish products. Individuals with a history of allergies may not find the products suitable. Fish oil or fish products may sometimes have interactions with other medications or products being consumed by individuals.

Medications regarded as relatively safe among all class of medications

Statin class of medications are considered as medications with relatively lesser side effects. It is precisely because of the relatively better side effect profile of the medication, that it is most commonly prescribed. Apart from the possible risk of a slight increase in blood glucose levels, the medication is relatively safe with more effective mechanism of action. The proven results of the medications combined with the relatively lower side effects, make it a popular choice for specialists. When prescribed in lower doses, statins are effectively the best cholesterol medication with least side effects. The benefits of statin class of medications are significant and this easily dwarfs the negligible side effects of the medication.

One of the distinct features of statins are the ability to maintain plaque in blood vessels. In other words, plaque in the blood is stabilized by statins. This helps to prevent heart attacks and stroke in patients. One of the reasons for heart attack or stroke is the breaking off of plaque, which results in heart attacks. When plaque is stabilized, it reduces risk of cardiovascular events. Statins also reduce inflammation, which helps in preventing health complications, making it one of the best cholesterol medication with least side effects.

Recommended practices to be followed by individuals on cholesterol medications

Patients on cholesterol lowering medications are expected to diligently follow the instructions of the treating specialist. To avoid side effects of medications, it is important to be cautious to prevent drug interactions. The mechanism of action of cholesterol lowering drugs may interact with the mechanism of action of other medications used for other existing conditions. It is therefore necessary to inform the healthcare provider about other medications and conditions, which will help the healthcare provider to prescribe the right kind of medications. The dosage, frequency and other lifestyle, dietary modifications are to be followed as instructed. While it is important to choose the best cholesterol medication with least side effects, it is essential to maintain a routine of taking the medications at the right time/frequency. Missed dosages and overdoses can result in possible adverse consequences, and patients are therefore advised to exercise utmost caution when on the medication.

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