LDL-lowering medications: how to get a 20%, 50%, or 80% reduction

Modern medicines are miracles that can lower LDL cholesterol by up to 85%. Which exact set of medications are right for you is a conversation between you and your doctor, and partly depends on your starting point. An LDL cholesterol of 160 mg/dL will almost certainly need medications to reach <100 mg/dL, whereas an LDL of 110 mg/dL might be in the range for lifestyle.

This guide walks through all of the interventions that lower your LDL: diet, statins, Zetia, PCSK9 inhibitors, and more.

We’ll work backward from the reduction you need, using a cheat sheet built from our intervention evidence database. Then we’ll answer how much each medication lowers LDL, compare common choices, and show what combining them could achieve. Our ApoB medication guide covers the related particle measurement; the numbers here refer specifically to LDL cholesterol.

How much do you need to lower LDL cholesterol?

The 2026 AHA/ACC guidelines set LDL targets below 100, 70, or 55 mg/dL, depending on cardiovascular risk and medical history. For the target you and your clinician choose:

Required reduction = (current LDL − target LDL) ÷ current LDL × 100.

Starting LDL (mg/dL)	Target LDL (mg/dL)	Example medications	Reduction
125	100	Add ezetimibe 10 mg to existing therapy	20%
160	100	Atorvastatin 20 mg or simvastatin 40 mg	About 38%
140	70	Rosuvastatin 20 mg or atorvastatin 80 mg	50%
180	70	Rosuvastatin 20 mg + ezetimibe 10 mg	About 61%
275	55	Rosuvastatin 20 mg + ezetimibe 10 mg + evolocumab	80%

The percentages show the change from starting to target LDL; the medications can provide roughly that reduction or more. Only the first row starts from treated LDL. Responses vary; combination estimates use the calculation below.

Which medications lower LDL cholesterol the most?

The cheat sheet compares medication doses, dietary changes, and two calculated combinations:

Circles: changes from baseline. Diamonds: differences versus the study comparator. Squares: calculated combinations. Whiskers: 95% confidence intervals, not individual response ranges. Populations, background therapy, and follow-up differ. Data and sources.

Browse the individual medication guides for dosing, side effects, cash prices, and insurer policies.

How much does each statin lower LDL?

Statins help the liver make less cholesterol and clear more LDL from blood. All seven have generic versions; prices depend on the pharmacy, dose, and insurance.

• Rosuvastatin (Crestor) lowers LDL about 46% at 10 mg/day, 52% at 20 mg, and 55% at 40 mg. Muscle-injury risk rises at 40 mg; severe kidney impairment limits dosing to 10 mg/day in patients not on hemodialysis. Prescribing information.
• Atorvastatin (Lipitor) lowers LDL about 37% at 10 mg/day, 43% at 20 mg, 48% at 40 mg, and 51% at 80 mg, similar to rosuvastatin 20 mg’s 52%. It needs no kidney-based dose adjustment, though certain antibiotics and antivirals can raise drug levels and muscle-injury risk. Prescribing information.
• Simvastatin (Zocor) lowers LDL about 28% at 10 mg/day, 35% at 20 mg, and 39% at 40 mg. Walmart lists those strengths at $9 for 30 tablets, with state and program restrictions. Avoid starting or increasing to 80 mg because of muscle-injury risk; interactions can also limit dosing. Prescribing information.
• Pravastatin (Pravachol) lowers LDL about 20% at 10 mg/day, 24% at 20 mg, and 30% at 40 mg. It has fewer drug interactions, though muscle symptoms remain possible. See the ACC’s statin comparison tool.
• Lovastatin lowered LDL about 24% at 20 mg once daily, 30% at 40 mg once daily, and 40% at 40 mg twice daily in EXCEL. Grapefruit and certain antibiotics or antifungals can increase lovastatin levels and muscle-injury risk. Trial results and prescribing information.
• Pitavastatin (Livalo, Zypitamag) lowers LDL about 31% at 1 mg/day, 39% at 2 mg, and 44% at 4 mg. Muscle symptoms remain possible; moderate or severe kidney impairment limits dosing to 2 mg/day. Prescribing information.
• Fluvastatin (Lescol) lowers LDL about 22% at 20 mg/day, 25% at 40 mg/day, and 36% at 40 mg twice daily. Fluconazole raises its levels and requires a dose limit for the capsules. Trial results and prescribing information.

The first four report six-week averages from STELLAR. The others use separate studies: EXCEL weeks 12–48, pitavastatin at 12 weeks in older adults, and fluvastatin medians at 24 weeks. Individual responses vary. Our statin guide covers other differences.

How much do non-statin medications lower LDL?

• Ezetimibe (Zetia) blocks intestinal cholesterol absorption. At 10 mg/day, it lowered LDL an additional 21% on a statin, or 17% versus placebo when used alone. Adding it to a statin also reduced cardiovascular events after acute coronary syndrome in IMPROVE-IT.
• Increase the statin dose or add ezetimibe? Doubling atorvastatin from 10 to 20 mg increased LDL lowering from 37% to 43% in STELLAR. In RACING, rosuvastatin 10 mg + ezetimibe 10 mg performed similarly to rosuvastatin 20 mg for cardiovascular events, with more patients reaching LDL below 70 and fewer reducing or stopping treatment because of side effects.
• Bempedoic acid (Nexletol) lowered LDL an additional 18% versus placebo on existing therapy at 180 mg/day, and reduced cardiovascular events in statin-intolerant patients. Combined with ezetimibe as Nexlizet, it lowered LDL 38% versus placebo. Gout and tendon injury are important risks. Prescribing information.
• PCSK9 inhibitors can lower LDL roughly another 50–60% on existing therapy. See the comparison below for medications, dosing, and cash prices.

PCSK9 antibodies can cost $225–$239/month cash and lower LDL about 60%

Evolocumab (Repatha) and alirocumab (Praluent) block PCSK9, preserving liver LDL receptors that clear cholesterol from blood. US cash programs advertise Praluent at $225 for two pens and Repatha at $239/month. September 2026 cash prices; eligibility requirements apply and insurance costs differ.

The oral PCSK9 inhibitor enlicitide (yellow) binds PCSK9 (teal), helping preserve LDL receptors (green) that clear cholesterol from blood. Read more about how this peptide works. Image: Merck & Co., Inc., via The Scientist.

Medication	LDL reduction	Treatment context
Repatha	59% versus placebo at 48 weeks	On statins; 140 mg every two weeks or 420 mg monthly. FOURIER
Praluent	47.2% from baseline	Alone; 75 mg every two weeks, increased to 150 mg per protocol. ODYSSEY MONO
Praluent	62-percentage-point advantage over placebo at 24 weeks	On statins; 150 mg every two weeks. ODYSSEY LONG TERM
Inclisiran (Leqvio)	49.9–52.3% versus placebo at day 510	On existing therapy; reduces PCSK9 production. Given initially, at three months, then every six months. ORION; label
Lerodalcibep (Lerochol)	About 50–59% versus placebo	On existing therapy; 300 mg monthly injection. FDA
Enlicitide (Lipfendra)	56% versus placebo in CORALreef Lipids; 59% in heterozygous familial hypercholesterolemia, at 24 weeks	On existing therapy; 20 mg daily pill. Label

Trial populations and regimens differ; similar LDL reductions don’t establish equal cardiovascular benefits. Lerochol and Lipfendra aren’t in the chart yet. Our Lipfendra guide explains its fasting requirements.

Other LDL-lowering medications

Bile-acid sequestrants (colesevelam, cholestyramine, and colestipol) lower LDL roughly 10–27%. Colesevelam lowered it 15% at about 3.8 g/day. Constipation, medication interactions, and increased triglycerides can limit their use.

Two specialist drugs treat homozygous familial hypercholesterolemia (HoFH), a rare inherited condition:

Medication	LDL result in HoFH	Main considerations
Evinacumab (Evkeeza)	49% versus placebo at 24 weeks on background therapy	Monthly infusion; works despite severely impaired LDL-receptor function. FDA label
Lomitapide (Juxtapid)	40% mean reduction from baseline at 26 weeks, adult intent-to-treat analysis	Requires liver monitoring, dietary restrictions, and interaction review. Label

Niacin lowers LDL, but adding it to intensive statin therapy didn’t reduce cardiovascular events in AIM-HIGH. Fibrates such as fenofibrate and gemfibrozil mainly treat high triglycerides: fenofibrate lowered LDL 20.6% in elevated-LDL trials, while gemfibrozil can raise LDL when triglycerides are very high.

How much can rosuvastatin + ezetimibe + a PCSK9 inhibitor lower LDL?

Each added medication lowers the LDL remaining. For rosuvastatin 20 mg, ezetimibe 10 mg, and evolocumab, use decimals (52% = 0.52):

Combined reduction = 1 − (1 − statin effect) × (1 − ezetimibe effect) × (1 − PCSK9 effect).

Starting at 160 mg/dL, this estimates LDL of 77 with rosuvastatin, 60 after adding ezetimibe, and 25 after adding evolocumab: reductions of 52%, 62%, and 85%.

Calculated using 52%, 21.4%, and 59% effects from separate trials, assuming each transfers to the combined regimen. These are illustrative estimates, not observed combination-trial results, individual forecasts, or recommended targets.

Statins vs PCSK9 inhibitors

High-intensity statins lower LDL roughly in half. In FOURIER, evolocumab lowered LDL another 59% versus placebo on statins. The choice depends on dosing, coverage, side effects, and cardiovascular benefits. See our comparison and insurance guide.

What if you can’t tolerate a statin?

Your clinician can review symptoms and interactions, then try a different statin or lower dose. Alternatives include ezetimibe, bempedoic acid, PCSK9 treatments, and bile-acid sequestrants.

When should you recheck LDL after changing medication?

The 2026 guideline recommends a lipid profile 4–12 weeks after starting or intensifying treatment. Use the result to calculate how much further LDL needs to fall.

Empirical Health’s comprehensive health panel measures LDL, ApoB, and other markers to assess your response. For diet changes, see our cholesterol-lowering food guide.