RIP Non-Statin Cholesterol Meds

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Guidelines change the way we practice medicine. This is a good thing because sweeping guidelines are based on interpretations of years of good strong studies. The new cholesterol guidelines place the burden of lowering LDL cholesterol on statin drugs because they work.

Lowering LDL cholesterol is now not just about chasing a number (70, 100, 130) but about lowering yours by 25-50% if you meet the indications for treatment. We will no longer add second medications in an effort to get to a “number,” because adding these medications to statins has never been shown to provide significant benefit in prevention of heart disease over statins alone. So here are five cholesterol medications that may go by the wayside.

1. Zetia (ezetimibe): This medication is supposed to lower cholesterol by preventing it from being absorbed from the intestine. It’s expensive. Added to a statin it provides no known benefit in prevention of heart disease. Remember Vytorin is the combination of Zetia and a statin and is no better than a statin alone.

2. Tricor (fenofibrate): While this medication may work to lower triglycerides and slightly lower your LDL, we have no evidence that Tricor provides any survival benefit to you. I guess if you can’t tolerate statin drugs and your triglycerides are really high your doctor may talk to you about using fenofibrate to lower them but we just don’t know how much that helps you for heart disease prevention. And, it’s expensive.

3. Niacin (nicotinic acid): This is just plain hard to take anyway due to the flushing, and niacin provides you no known added benefit when it comes to heart disease prevention.

4. Lopid (gembfibrozil): Again, gemfibrozil was occasionally added to statin drugs to lower triglycerides and raise HDL in addition to slightly raising LDL cholesterol but there isn’t enough evidence that this helps you or provides any benefit over a statin drug for prevention of heart disease.

5. Questran (cholestyramine): This is a powder you drink in water. Cholestyramine binds to bile acids in the intestine triggering the liver to produce more bile acids from the cholesterol in the blood, thereby lowering your cholesterol. Cool mechanism but there is no benefit for this in addition to statin drugs for heart disease prevention.

RIP non-statins.

Dr O.

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