Editing Lipid-lowering agent (section)

===Established===
* [[Statin]]s (HMG-CoA reductase inhibitors) are particularly well suited for lowering LDL, the cholesterol with the strongest links to vascular diseases. In studies using standard doses, statins have been found to lower LDL-C by 18% to 55%, depending on the specific statin being used. A risk exists of muscle damage ([[myopathy]] and [[rhabdomyolysis]]) with statins. Hypercholesterolemia is not a risk factor for mortality in persons older than 70 years and risks from statin drugs are more increased after age 85.<ref>{{Citation |author1 = AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA – The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Ten Things Physicians and Patients Should Question |publisher = AMDA – The Society for Post-Acute and Long-Term Care Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = 20 April 2015}}.</ref>  
* [[Fibrate]]s are indicated for [[hypertriglyceridemia]]. Fibrates typically lower triglycerides by 20% to 50%. Level of the good cholesterol HDL is also increased. Fibrates may decrease LDL, though generally to a lesser degree than statins. Similar to statins, the risk of muscle damage exists.
* [[Nicotinic acid]], like fibrates, is also well suited for lowering triglycerides by 20–50%. It may also lower LDL by 5–25% and increase HDL by 15–35%. Niacin may cause [[hyperglycemia]] and may also cause [[hepatotoxicity|liver damage]]. The niacin derivative [[acipimox]] is also associated with a modest decrease in LDL. Introduced in 1955.
* [[Bile acid sequestrant]]s (resins, e.g. cholestyramine) are particularly effective for lowering LDL-C by sequestering the cholesterol-containing bile acids released into the intestine and preventing their reabsorption from the intestine. It decreases LDL by 15–30% and raises HDL by 3–5%, with little effect on triglycerides, but can cause a slight increase. Bile acid sequestrants may cause gastrointestinal problems and may also reduce the absorption of other drugs and vitamins from the gut.
* [[Ezetimibe]] is a selective inhibitor of dietary cholesterol absorption.
* [[Lomitapide]] is a [[microsomal triglyceride transfer protein]]  inhibitor.
* [[PCSK9]] inhibitors<ref>Koren MJ, Scott R, Kim JB et al Lancet 2012; 380:1995-2006</ref><ref>Gugliano RP, Desai NR, Kohli P et al Lancet 2012; 380:2007-17</ref> are [[monoclonal antibody|monoclonal antibodies]] for refractory cases. (e.g. [[Evolocumab]], [[Inclisiran]]) They are used in combination with [[statin]]s.
* [[Probucol]] decreases LDL independently of the LDL receptor, and decreases HDL-C by enhancing its liver receptor and reducing ABCA1-dependent transport. The reduction of HDL-C, combined with early uncertainties around its mechanism of action, has historically lead to its discontinuation and replacement by statins in Western countries. However, instead of lowering [[reverse cholesterol transport]] by HDL particles, probucol seems to increase it. Introduced in the 1970s.<ref name="pmid26125504">{{cite journal |vauthors=Yamashita S, Masuda D, Matsuzawa Y |title=Did we abandon probucol too soon? |journal=Current Opinion in Lipidology |volume=26 |issue=4 |pages=304–16 |date=August 2015 |pmid=26125504 |doi=10.1097/MOL.0000000000000199 |quote=Probucol has been used as a lipid-lowering drug for a long time especially in Japan, although Western countries quitted its use because of the reduction in serum HDL-cholesterol (HDL-C).}}</ref> It predated the statins by about a decade.<ref name="pmid32507832">{{cite journal |vauthors=Yamashita S, Masuda D, Matsuzawa Y |title=New Horizons for Probucol, an Old, Mysterious Drug |journal=Journal of Atherosclerosis and Thrombosis |volume=28 |issue=2 |pages=100–102 |date=February 2021 |pmid=32507832 |pmc=7957029 |doi=10.5551/jat.ED132}}</ref>