Hypolipidemic agent

Lipid-modifying agents, also known as lipid-lowering agents, are a group of medications used to lower the levels of cholesterol and other lipids in the blood. High levels of lipids in the blood, particularly LDL cholesterol, are a major risk factor for cardiovascular disease. Lipid-modifying agents work by inhibiting the production of lipids in the liver, increasing the clearance of lipids from the blood, or both.

Classes

There are several classes of lipid-modifying agents, including:

1. Statins: Statins are the most commonly prescribed lipid-modifying agents. They work by inhibiting HMG-CoA reductase, an enzyme involved in the production of cholesterol in the liver. By reducing cholesterol production, statins lower LDL cholesterol levels and may also raise HDL cholesterol levels. Examples of statins include atorvastatin, simvastatin, and rosuvastatin.
2. Ezetimibe: Ezetimibe is a medication that inhibits the absorption of cholesterol in the small intestine. It is often used in combination with a statin to further lower LDL cholesterol levels. Examples of combination products include ezetimibe/simvastatin and ezetimibe/atorvastatin.
3. Bile acid sequestrants: Bile acid sequestrants are medications that bind to bile acids in the intestine, preventing their reabsorption. This leads to an increased excretion of bile acids in the feces and a decrease in cholesterol levels. Examples of bile acid sequestrants include cholestyramine and colesevelam.
4. Fibrates: Fibrates are medications that lower triglyceride levels in the blood and may also increase HDL cholesterol levels. They work by activating PPAR-alpha, a receptor involved in the metabolism of lipids. Examples of fibrates include gemfibrozil and fenofibrate.
5. Niacin: Niacin, also known as vitamin B3, is a medication that can lower LDL cholesterol and triglyceride levels while raising HDL cholesterol levels. It works by inhibiting the production of very low-density lipoprotein (VLDL) particles in the liver. Niacin is available over-the-counter and in prescription-strength formulations.
6. PCSK9 inhibitors: PCSK9 inhibitors are a relatively new class of lipid-modifying agents that work by inhibiting the PCSK9 protein, which is involved in the clearance of LDL cholesterol from the blood. By inhibiting PCSK9, these medications can lower LDL cholesterol levels. Examples of PCSK9 inhibitors include alirocumab and evolocumab.
7. Omega-3 fatty acids: Omega-3 fatty acids are natural substances found in fish oil that have been shown to have lipid-lowering effects. They work by reducing the production of triglycerides in the liver and increasing their clearance from the bloodstream. In addition to their lipid-lowering effects, omega-3 fatty acids also have anti-inflammatory and anti-arrhythmic properties, which may be beneficial for cardiovascular health. Omega-3 fatty acids are available as dietary supplements and are often recommended for people with high triglyceride levels.

Side effects

Lipid-modifying agents are generally safe and well-tolerated, but like all medications, they can cause side effects. Common side effects include muscle aches and pains, gastrointestinal upset, and liver function abnormalities. Rare but serious side effects can include muscle breakdown and liver failure. As with all medications, lipid-modifying agents should only be taken under the guidance of a healthcare professional.

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