How cholesterol medications work: Statins, ezetimibe, and PCSK9 inhibitors

Why treat high cholesterol?

The role of cholesterol in the body

Cholesterol is a substance naturally present in the body. It helps form cell membranes and certain hormones.

The problem occurs when certain forms of cholesterol, particularly LDL cholesterol, often called “bad cholesterol", build up excessively in the blood.

A risk that builds over time

High levels of LDL cholesterol promote the formation of deposits in the arteries, a process known as atherosclerosis.

This process develops gradually and silently over many years before it may lead to cardiovascular complications.

A comprehensive approach to cardiovascular risk

Cholesterol treatment is not based only on a blood test result. It takes into account a person’s overall cardiovascular risk, including age, medical history, and the presence of other factors such as high blood pressure or diabetes.

This broader approach explains why treatments are adapted to each individual situation.

Statins: The most commonly used treatments

How do statins work?

Statins mainly act on the liver by reducing cholesterol production.

This decrease leads to lower levels of LDL cholesterol circulating in the blood.

Treatments studied for several decades

Statins are the most widely prescribed and most extensively studied cholesterol-lowering treatments.

Scientific evidence shows that they can reduce the risk of cardiovascular events in certain people at risk.

A treatment experience that varies between patients

Some people tolerate long-term treatment very well, while others report side effects, particularly muscle-related symptoms.

This variability can influence how people feel about treatment and whether they continue taking it over time.

Ezetimibe, PCSK9 inhibitors, and other treatments: What are the differences?

Ezetimibe: Limiting cholesterol absorption

Unlike statins, ezetimibe mainly acts in the intestine by reducing the absorption of dietary and bile cholesterol.

It may be used alone or in combination with a statin when cholesterol remains high despite treatment.

PCSK9 inhibitors: A more recent approach

PCSK9 inhibitors are newer treatments that increase the liver’s ability to remove LDL cholesterol from the blood.

They often lead to significant reductions in cholesterol levels, particularly in certain people at very high cardiovascular risk or those with familial hypercholesterolaemia.

Bempedoic acid: An alternative in certain situations

Bempedoic acid also acts on cholesterol production in the liver, but through a different mechanism from statins.

It may be offered to some people who do not tolerate statins well or when LDL cholesterol targets are not reached.

Fibrates and treatments targeting triglycerides

Fibrates are mainly used when triglycerides are elevated. They work differently from statins and may sometimes be combined with other treatments depending on a person’s lipid profile.

Some omega-3-derived treatments may also be prescribed in specific situations.

New targeted therapies

Newer treatments, such as inclisiran, use innovative technologies based on small interfering RNA to sustainably reduce the liver’s production of PCSK9.

These approaches allow for prolonged reductions in LDL cholesterol, with injections spaced out over time.

Increasingly personalised care

Today, cholesterol treatment is no longer based on a one-size-fits-all approach. The choice of medication depends on overall cardiovascular risk, lipid profile, medical history, and treatment tolerance.

This shift allows for more individualised care, adapted to each person’s health journey.

Living with cholesterol treatment day to day

An often invisible condition

Hypercholesterolaemia usually causes no symptoms before a cardiovascular complication occurs.

This lack of visible signs can make it difficult to understand the importance of treatment in daily life.

The long-term relationship with treatment

Taking a long-term medication can raise questions or concerns, especially around side effects or how long treatment will be needed.

Over time, some people develop a better understanding of their cardiovascular risk and the role treatment plays in their overall care.

Care that continues to evolve

Knowledge about cholesterol and cardiovascular disease is evolving quickly. New treatments continue to be developed, offering more therapeutic options.

This progress is making care increasingly personalised according to each patient’s profile.

FAQ: Cholesterol treatments

What are statins used for?

They mainly reduce cholesterol production by the liver.

What is the difference between statins and ezetimibe?

Statins reduce cholesterol production, while ezetimibe reduces its absorption in the intestine.

What are PCSK9 inhibitors?

They are newer treatments that increase the liver’s removal of LDL cholesterol from the blood.

Why treat high cholesterol if there are no symptoms?

Because cardiovascular risk often develops silently over many years.

Are cholesterol treatments taken for life?

It depends on each person’s cardiovascular situation and overall health profile.

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Take care!