胆固醇药物

Help to control your cholesterol levels

对一些人来说, 生活方式的改变, such as a healthier diet and more physical activity, may prevent or treat unhealthy cholesterol levels. For others with high cholesterol, medication may also be needed.

与你的医疗保健专业人员一起制定适合你的治疗计划. If medication is required, be sure to take it as prescribed. 这些药物对你的健康有潜在的好处，值得你把它们作为日常生活的一部分.

降胆固醇药物的种类

Various medications can lower blood cholesterol levels.

他汀类药物被推荐给大多数患者，并与降低心脏病发作或中风的风险直接相关. 在大多数情况下，他汀类药物仍然是最有效的降脂治疗.

指南建议这些人群与他们的医疗保健专业人员讨论他汀类药物治疗的风险和益处:

• 有心血管疾病史的成年人，包括由动脉粥样硬化引起的中风
• Those with LDL-C level of greater than 190 mg/dL
• 40-75岁的糖尿病患者
• Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 5% to 19.动脉粥样硬化和风险增强因素导致心血管疾病的10年风险为9%
• 40-75岁的成年人，LDL-C水平为70-189 mg/dL, 10年发生动脉粥样硬化心血管疾病的风险在20%或以上

一些不属于这些类别的人也可能从他汀类药物治疗中受益.

与你的医疗保健专业人员谈谈你10年或一生的风险是很重要的. 他们会评估你的风险因素，以确定你的风险水平，并与你一起选择最好的治疗方法.

View an interactive slideshow to see how cholesterol drugs work.

本节总结了一些常用的心血管药物的主要类型. 我们列出了通用名称和主要商品名称，以帮助您确定您可能服用的药物. 请理解 美国心脏协会不推荐或认可任何特定的产品. If your prescription medication isn’t on this list, 你的医疗保健专业人员和药剂师是你最好的信息来源. 与你的医疗保健专业人员讨论你服用的所有药物，了解它们的预期效果和可能的副作用是很重要的. 在没有咨询你的医疗保健专业人员之前，不要停止服药或改变你的剂量(或频率). Some cholesterol-lowering medications may interact with grapefruit, 葡萄柚汁, 石榴和石榴汁. Please talk to your health care professional about any potential risks.

他汀类药物

这类药物, also known as HMG CoA reductase inhibitors, works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. 他汀类药物 are most effective at lowering LDL (bad) cholesterol. 它们还有助于降低甘油三酯(血脂)和提高高密度脂蛋白(有益的)胆固醇.

在开始服用他汀类药物之前，向你的医疗保健专业人员咨询可能的副作用. Most side effects are mild and go away as your body adjusts. Muscle pain is uncommon and liver abnormalities are rare, but your health care professional may order regular liver function tests. 孕妇和患有活动性或慢性肝病的妇女应与其保健专业人员讨论他汀类药物的使用 

他汀类药物在美国上市.S. 包括:

• 阿托伐他汀(立普妥®)
• Fluvastatin (Lescol®)
• Pitavastatin (Livalo®)
• 洛伐他汀(Mevacor®，Altoprev™)
• 普伐他汀()®)
• 瑞舒伐他汀钙(Crestor®)
• 辛伐他汀(辛伐他汀®)
• 产品组合:
  • Lovastatin/niacin extended-release (Advicor®)
  • Simvastatin/niacin extended-release (Simcor®)
  • 依折麦布/辛伐他汀(Vytorin®)

如果他汀类药物帮不了你, 或者出现了副作用, your health care professional may recommend different medications. 

如果你有心血管疾病，并且已经在服用最高耐受性的他汀类药物，而你的LDL-C仍然在70或以上, one or more of the following medicines may be prescribed. They all can be taken in combination with a statin.

Ezetimibe (cholesterol absorption inhibitors)

Prevents cholesterol from being absorbed in the intestine. It’s the most commonly used non-statin agent.

胆汁酸固存剂

也被称为胆汁酸结合剂，使肠道排出更多的胆固醇. 

在美国可以买到的.S. 包括:

• 消胆胺(Questran®、Questran®Light、Prevalite®、Locholest®、Locholest®Light)
• 降脂树脂ⅱ号(Colestid®)
• Colesevelam Hcl (WelChol®)

PCSK9抑制剂

PCSK9抑制剂 are powerful LDL-lowering drugs. 它们与肝脏细胞中的一种蛋白质结合并使其失活，以降低低密度脂蛋白(有害)胆固醇. Some names are alirocumab and evolocumab.

Adenosine triphosphate-citrate lyase (ACLY) inhibitors*

ACLY inhibitors work in the liver to block the production of cholesterol. 它们与生活方式的改变和他汀类药物联合使用，以进一步降低患有遗传性高胆固醇的成年人和需要进一步降低LDL的心脏病患者的LDL胆固醇.

• 苯二甲酸(耐来妥)
• Bempedoic acid and ezetimibe (Nexlizet)

*Adenosine triphosphate-citrate lyase (ACLY) inhibitors are not in the current Guideline on the Management of Blood 胆固醇因为它们在2020年获得了FDA的批准. For more information on ACL inhibitors visit the 国家医学图书馆(链接在新窗口中打开).

The following triglyceride-lowering drugs have mild LDL-lowering action, but data doesn’t support their use as an add-on treatment to statins.

一类

贝特酸盐特别有利于降低甘油三酯(血脂)水平，并有轻微的降低低密度脂蛋白的作用. 

在美国可以买到纤维制品.S. 包括:

• 二甲苯氧庚酸(诺稀®)
• Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)
• 非纤维酸(Fibricor®和Trilipix®)

烟酸(烟酸)

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your health care professional has prescribed it. It lowers triglycerides and has mild LDL-lowering action.

Niacin side effects may include flushing, itching and upset stomach. Your liver functions may be closely monitored because niacin can cause toxicity. 非处方立即释放的烟酸通常有最大的副作用, 特别是在高剂量下. 烟酸在糖尿病患者中谨慎使用，因为它会提高血糖水平.

Niacin comes in prescription form and as a dietary supplement. 膳食补充剂烟酸不能作为处方烟酸的替代品，因为它有潜在的严重副作用. 膳食补充剂烟酸不受食品和药物管理局的监管，可能含有大量的烟酸——从零到远远超过标签上的含量. 同一种膳食补充剂品牌的烟酸含量甚至会有所不同. Consult your health care professional before starting any niacin therapy.

Omega-3脂肪酸乙酯

These are derived from fish oils that are chemically changed and purified. 它们与饮食变化一起使用，以帮助甘油三酯水平高的人.

Omega-3脂肪酸乙酯 available in the U.S. 包括:

• Lovaza®
• Vascepa™
• Epanova®
• Omtryg®

Marine-derived omega-3 polyunsaturated fatty acids (PUFA)

Commonly referred to as omega-3 fish oils or omega-3 fatty acids, these are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and clear triglycerides. 显著降低甘油三酯所需的海洋来源的omega-3 PUFAs(2 - 4克)很难仅从日常饮食中获得, so supplementing with capsules may be needed.

只有在医疗保健专业人员的指导和照顾下才能使用这些补充剂, because large doses may cause serious side effects. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in people with diabetes. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. 对鱼过敏的人, shellfish or both may have a severe adverse reaction to using these supplements. Ask your health care professional if these are appropriate for you to take.