How Do Other Lipid-Lowering Agents Work?

Lipid-lowering agents are medications used to reduce the risk of heart attacks, by lowering abnormally high levels of blood fats (lipids) including cholesterol and triglycerides, which can build up in the arterial walls, obstructing free blood flow. Other lipid-lowering agents are medications that are not categorized into any specific class of lipid-lowering agents.

Other lipid-lowering agents work in different ways to reduce lipid levels, and include the following:

• Icosapent: Icosapent is a synthetic derivative of eicosapentaenoic acid (EPA), one of the three main omega-3 fatty acids. Icosapent reduces blood fat levels by reducing the synthesis and/or secretion of very-low-density lipoprotein triglycerides (VLDL-TG) in the liver and enhances the clearance of triglycerides from circulating VLDL particles.
• Icosapent inhibits acyl-CoA:1,2-diacylglycerol acyltransferase (DGAT), a protein essential for triglyceride synthesis in the liver, and enhances the activity of lipoprotein lipase, an enzyme that degrades triglycerides in the bloodstream. Icosapent may also increase the breakdown of fats in a process known as beta-oxidation in the liver, to produce energy.
• Niacin (vitamin B3): Niacin is a water-soluble vitamin and a component essential for lipid metabolism, in addition to other functions. Niacin lowers blood lipid levels by inhibiting the release of free fatty acids from fat tissue, increasing the activity of lipoprotein lipase, and decreasing the hepatic synthesis of VLDL and LDL.
• Omega-3 fatty acids: Omega 3 fatty acids are ethyl esters containing two types of fatty acids, eicosapentaenoic acid and docosahexaenoic acid (DHA). Omega-3 fatty acids reduce the synthesis of triglycerides in the liver, increase beta-oxidation in the liver and increase the activity of lipoprotein lipase and degradation of triglycerides in the bloodstream.
• Omega-3 carboxylic acids: Omega 3 carboxylic acids are free fatty acids containing EPA and DHA, and work similarly to omega-3 fatty acid ethyl esters. Both forms of omega-3 fatty acids are derived from fish oil. Currently, Omega-3 carboxylic acids production has been discontinued by the manufacturer and the product is not available in the US.

Other lipid-lowering agents are oral tablets and capsules used in the treatment of the following:

• Icosapent:
  • Severe hypertriglyceridemia, as an adjunct to diet to reduce triglyceride levels and cardiovascular risk in adult patients who have cardiovascular disease or diabetes mellitus and other risk factors for cardiovascular disease
• Niacin (vitamin B3):
  • Hyperlipidemia (high level of lipids in the blood)
  • A nutritional and dietary supplement to correct vitamin B3 deficiency
  • Pellagra, a systemic disease caused by vitamin B3 deficiency (off-label)
• Omega-3 fatty acids:
  • Hypertriglyceridemia, as an adjunct to diet to reduce triglyceride levels and cardiovascular risk in adult patients
  • Omega 3 fatty acid deficiency in cardiovascular patients
• Omega-3 carboxylic acids:
  • Hypertriglyceridemia, as an adjunct to diet to reduce triglyceride levels and cardiovascular risk in adult patients

Side effects of other lipid-lowering agents vary with each drug. A few of the most common side effects may include:

• Icosapent:
  • Bleeding event
  • Musculoskeletal pain
  • Peripheral edema
  • Constipation
  • Gout
  • Atrial fibrillation or flutter
• Niacin (vitamin B3):
  • Reversible increase in serum aminotransferase (liver enzyme)
  • Flushing
  • Rash and pruritus (itching)
  • Diarrhea
  • Headache
  • Arrhythmias (irregular heart rhythms)
• Omega-3 fatty acids:
  • Eructation (belching)
  • Infection
  • Flu-like syndrome
  • Dyspepsia (indigestion)
  • Back pain
  • Rash or urticaria (hives)
  • Angina pectoris (chest pain)
• Omega-3 carboxylic acids:
  • Diarrhea
  • Nausea and vomiting
  • Abdominal pain/discomfort
  • Eructation
  • Flatulence
  • Dysgeusia (taste disorder)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some of the other lipid-lowering agents include:

• Epanova (discontinued)
• icosapent
• Lovaza
• niacin
• Niacor
• Niaspan
• nicotinic acid
• omega 3 carboxylic acids (discontinued)
• omega 3 fatty acids
• Omega-3-acid ethyl esters
• Omtryg
• Vascazen
• Vascepa
• vitamin B3