Statin Drugs (M Clearfield, Section Editor)

Current Atherosclerosis Reports

, Volume 14, Issue 1, pp 33-40

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

A Review of the Rationale for Additional Therapeutic Interventions to Attain Lower LDL-C When Statin Therapy Is Not Enough

  • Jeffrey G. ShanesAffiliated withClinical Medicine, Rosalind Franklin University of Medicine and ScienceConsultants in Cardiovascular Medicine Email author 


Statins alone are not always adequate therapy to achieve low-density lipoprotein (LDL) goals in many patients. Many options are available either alone or in combination with statins that makes it possible to reach recommended goals in a safe and tolerable fashion for most patients. Ezetimibe and bile acid sequestrants reduce cholesterol transport to the liver and can be used in combination. Niacin is very effective at lowering LDL, beyond its ability to raise high-density lipoprotein and shift LDL particle size to a less atherogenic type. When statins cannot be tolerated at all, red yeast rice can be used if proper formulations of the product are obtained. Nutrients can also be added to the diet, including plant stanols and sterols, soy protein, almonds, and fiber, either individually or all together as a portfolio diet. A clear understanding of how each of these strategies works is essential for effective results.


Statins Cholesterol Bile acid sequestrants Colesevelam Cholestyramine Ezetimibe Niacin Fibrates Red yeast rice Fiber Plant stanols Plant sterols Soy protein Almonds Dietary portfolio LDL cholesterol