Cholesterol-lowering drugs are medications that reduce the level of cholesterol in the blood, primarily by lowering low-density lipoprotein (LDL) cholesterol (‘bad cholesterol’), which is the main driver of atherosclerotic plaque formation in artery walls. Reducing LDL cholesterol is one of the most evidence-based interventions for preventing heart attack, stroke, and sudden cardiac arrest.
Statins are the most important and widely used class of cholesterol-lowering drug. They work by inhibiting HMG-CoA reductase, the enzyme responsible for cholesterol synthesis in the liver, and also stabilise atherosclerotic plaques by reducing inflammation in the artery wall. High-intensity statins (atorvastatin 80mg or rosuvastatin 40mg) are recommended for most people at high cardiovascular risk, including the majority of cardiac arrest survivors. For every 1 mmol/L reduction in LDL, the risk of a major cardiovascular event falls by approximately 20 to 25%.
When statins alone do not achieve the target LDL (below 1.4 mmol/L for very high-risk patients), additional drugs are used. Ezetimibe reduces cholesterol absorption from the gut and is often added to statin therapy. PCSK9 inhibitors (injectable monoclonal antibodies that dramatically lower LDL by increasing liver clearance) are used for patients at very high risk or those with familial hypercholesterolaemia.
Cholesterol-lowering drug treatment is a lifelong component of secondary prevention for most cardiac arrest survivors with coronary artery disease. Statins should not be stopped without medical advice, as doing so significantly increases the risk of recurrent cardiac events.
« Back to Glossary Index