Which class of drugs is considered the first choice for lowering cholesterol levels?

Statins are considered the first choice for lowering cholesterol levels due to their effectiveness in reducing low-density lipoprotein (LDL) cholesterol, which is a key target in the management of cardiovascular disease risk. Statins work by inhibiting HMG-CoA reductase, an enzyme involved in the cholesterol biosynthesis pathway in the liver. This results in a decrease in overall cholesterol production, leading to lower LDL levels in the bloodstream.

Moreover, statins provide additional cardiovascular benefits beyond cholesterol lowering. They have been shown to stabilize atherosclerotic plaques, reduce inflammation, and improve endothelial function, which contributes to their effectiveness in preventing cardiovascular events such as heart attacks and strokes.

While other classes of drugs, such as fibrates, bile acid resins, and niacin, can also lower cholesterol levels, they are typically not utilized as first-line agents. Fibrates primarily decrease triglycerides and may have modest effects on LDL, bile acid resins work by binding bile acids in the intestine to prevent their reabsorption, and niacin has a complicated side effect profile, including flushing and potential liver toxicity. Therefore, the evidence base supporting the safety and efficacy of statins makes them the preferred first-line treatment for cholesterol reduction in patients at risk for cardiovascular