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• Statin therapy also decreases the incidence of major cerebrovascular events (stroke) in people without known cardiovascular disease.

• Statin therapy does not reduce the risk of death from a fatal heart attack and does not reduce overall mortality from other causes in people without known cardiovascular disease.

Examples of specific statin medications that may be used to lower LDL cholesterol levels in the bloodstream include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Altoprev; Mevacor)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Adverse effects of statin drugs appear to be dose-related and tend to occur more frequently in patients taking higher doses of these medications. Adverse effects also tend to occur more frequently when statin drugs are used in combination with other cholesterol-lowering medications, such as niacin and fibrates. The most common side-effects of statin medications include non-specific muscles aches and pain that are reported to occur in about 5% of people. Elevated liver enzymes develop in up to 1% of people. The most serious adverse effect is a condition called rhabdomyolysis - a serious and potentially life-threatening condition involving destruction of skeletal muscles. Fortunately, this side-effect is rare with less than one death per million patients.

Bile Acid Sequestrants

Bile acid sequestrants are medications that are often prescribed along with statins to reduce levels of LDL cholesterol in the bloodstream. Bile acids are substances needed for digestion that are produced by the liver using cholesterol as a substrate. Bile acid sequestrants are medications that bind to bile acids which forces the liver to use more cholesterol to produce bile acids. The overall effect is a reduction in LDL cholesterol levels by about 10% to 20%.

Examples of bile acid sequestrants include:

• Cholestyramine (Prevalite; Questran)
• Colestipol (Colestid)
• Colesvelam (WelChol)

Side-effects of bile acid sequestrants may include:

• Bloating
• Constipation
• Gas
• Nausea

Nicotinic Acid

Studies have shown that nicotinic acid or niacin lowers total cholesterol; lowers LDL cholesterol; and lowers triglyceride levels. It also increases the levels of HDL or "good" cholesterol. Although nicotinic acid is available over-the-counter, a prescription form of this product is also available (e.g., Niaspan). The prescription form of nicotinic is preferred and should be used under the care and supervision of a physician.

Possible serious side-effects of nicotinic acid may include:

• Gout
• High blood sugar
• Liver problems
• Stomach irritation

Fibrates

Fibrates are medications that can reduce triglyceride levels by as much as 20% to 50%, however, they are not very effective for reducing blood levels of LDL cholesterol. Fibrates can also increase levels of HDL cholesterol by up to 15%.

Examples of fibrates include:

• Gemfibrozil (Lopid)
• Fenofibrate (Lofibra; Tricor)

Side-effects of fibrates may include:

• Elevated liver enzymes
• Gallstones
• Interaction with anticoagulant medications
• Nausea

Ezetimibe

Ezetimibe (Zetia) belongs to a new class of cholesterol-lowering medications known as cholesterol absorption inhibitors. Ezetimibe lowers the levels of blood cholesterol by limiting the absorption of dietary cholesterol by the small intestine. The most common side-effects are back pain and joint pain. Ezetimibe may be used alone or it may be used in combination with a statin drug.