Which drug decreases cholesterol production by the liver?

The drug that decreases cholesterol production by the liver is correctly identified as an HMG coenzyme A reductase inhibitor. This class of medications works by inhibiting the HMG-CoA reductase enzyme, which plays a critical role in the cholesterol biosynthesis pathway. By blocking this enzyme, HMG-CoA reductase inhibitors effectively reduce the liver's ability to produce cholesterol, leading to lower levels of total cholesterol and low-density lipoprotein (LDL) cholesterol in the bloodstream.

This mechanism is particularly important because elevated levels of LDL cholesterol are associated with an increased risk of cardiovascular diseases, such as heart attacks and strokes. Therefore, HMG-CoA reductase inhibitors are considered first-line agents in the treatment of hyperlipidemia and are commonly prescribed to help manage cholesterol levels.

Statins, which are a common name for HMG-CoA reductase inhibitors, also fit this description, but the question specifically refers to the mechanism of action rather than the class name. Other drug classes, like fibrates and bile acid sequestrants, have different mechanisms of action, primarily affecting triglyceride levels or utilizing other pathways to lower cholesterol but do not directly inhibit cholesterol production in the liver in the same way that HMG-CoA reductase inhibitors do.