Lipid Lowering Agents

Question 1

HMG-CoA reductase inhibitors (statins)

Answer 1

DECREASE LDL CHOLESTEROL, mildly increase HDL, mildly decrease triglycerides.

Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor.

Side effects:

1. Hepatotoxicity (increase LFTs).
2. Rhabdomyolysis (especially when used with fibrates and niacin).

Question 2

Niacin (Vitamin B3)

Answer 2

INCREASE HDL. Mildly decrease LDL, mildly decrease triglycerides.

Inhibits lipolysis in adipose tissue, reduces hepatic VLDL synthesis.

Side effects: Red, flushed face, which is decreased by aspirin or long-term use.

• Hyperglycemia
• Hyperuricemia (exacerbates gout)

Remember: sweet, flushed, lips

Question 3

Bile acid resins

Answer 3

Cholestyramine, cholestipol, colesevelam.

Decrease LDL, slightly increase LDL, slightly INCREASE triglycerides.

Prevents intestinal re-absorption of bile acids; liver must use cholesterol to make more. Inhibits