Which medication activates an enzyme that breaks down cholesterol?

Gemfibrozil is a medication that activates peroxisome proliferator-activated receptor alpha (PPAR-alpha), which plays a crucial role in the regulation of lipid metabolism. By activating this enzyme, gemfibrozil enhances the activity of lipoprotein lipase, leading to increased breakdown of triglycerides and a reduction in levels of triglycerides in the blood. While it does not directly break down cholesterol in the same manner as some other agents, its action results in favorable changes to the lipid profile, including the reduction of cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol and an increase in high-density lipoprotein (HDL) cholesterol.

This mechanism reflects how gemfibrozil can be effective in managing cholesterol levels and reducing the risk of cardiovascular diseases associated with high cholesterol. Other medications mentioned in the options, like alirocumab and evolocumab, primarily act as PCSK9 inhibitors to lower LDL cholesterol, while niacin exerts its effect by inhibiting the mobilization of fatty acids, ultimately leading to changes in lipid levels but not through activating an enzyme to break down cholesterol directly.