cholesterolverlagers

Cholesterolverlagers are medicines used to lower blood cholesterol levels, especially low-density lipoprotein cholesterol (LDL-C), with the aim of reducing the risk of atherosclerotic cardiovascular disease. They may be prescribed alone or in combination with lifestyle changes such as diet and exercise, and they are a central component of modern lipid management.

Statins (HMG-CoA reductase inhibitors) are the most widely used class and are usually considered first-line therapy. By inhibiting hepatic cholesterol synthesis, statins upregulate LDL receptors and lower LDL-C by about 25–55% depending on potency and dose. Ezetimibe reduces intestinal absorption of cholesterol, providing additional LDL-C lowering. Bile acid sequestrants bind bile acids in the gut, shifting hepatic cholesterol metabolism and producing modest LDL-C reductions. PCSK9 inhibitors are monoclonal antibodies that increase LDL receptor availability, achieving large LDL-C reductions and are used in very high-risk patients or familial hypercholesterolemia. Other agents include bempedoic acid, which inhibits ATP citrate lyase, fibrates for triglyceride management, and, less commonly, niacin.

Indications typically include primary prevention in individuals at high cardiovascular risk, secondary prevention after myocardial infarction or stroke, and treatment of familial hypercholesterolemia. The choice of agent depends on baseline LDL-C, cardiovascular risk, comorbidities, tolerance, and cost. Efficacy is established in lowering LDL-C and, for several agents, reducing cardiovascular events.

Safety and monitoring require attention to potential adverse effects, such as muscle symptoms and liver enzyme elevations with statins, interactions with other drugs, and rare cases of rhabdomyolysis. Liver function tests and lipid panels are usually checked at baseline and during therapy, with dose adjustments or switches considered in cases of intolerance. Cholesterolverlagers remain a core element of cardiovascular risk reduction, with therapy tailored to the individual patient.