What Are Statins?
Statins are a group of drugs prescribed to lower cholesterol, protect against damage from coronary-artery disease and prevent heart attack. Statins are extremely effective in decreasing heart disease and preventing death. In terms of providing health benefits to a broad segment of the population, statins may be the most important drugs to emerge in recent times. Commonly prescribed statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), and rosuvastatin (Crestor).
Statins provide the greatest benefit to people with:
- Coronary heart disease
- Diabetes and one or more other risk factors for heart disease
- High cholesterol levels and other risk factors for heart disease
Keep in mind that you don't have to be a heart patient to benefit from statins. Indeed, statins may have benefits for people with moderately elevated cholesterol levels and more than an average risk of heart disease. The high risk factors include diabetes, cigarette smoking, high blood pressure, and family history of early onset coronary heart disease. You need to be aware of your own personal cardiac-risk profile to decide if you may benefit from this remarkable group of drugs.
What Are the Benefits of Taking Statins?
Statins lower the level of low-density-lipoprotein (LDL) cholesterol in your blood. Cholesterol is a type of lipid, a soft, fatlike substance. LDL cholesterol can build up on the walls of arteries, producing atherosclerotic plaque. Atherosclerotic plaque can clog the coronary arteries, causing coronary-artery disease and impeding blood flow. Taking a statin, as prescribed by your doctor, will help you to reach the target LDL-cholesterol level that is right for you. Further, it will reduce your risk of:
- Developing angina (chest pain resulting from clogged coronary arteries)
- Having a heart attack (which may occur if clogged arteries prevent blood from reaching the heart muscle)
- Experiencing sudden cardiac death
Statins also slightly raise levels of high-density-lipoprotein (HDL) cholesterol. Unlike LDL cholesterol, high levels of HDL cholesterol are an indication of cardiac health. For more information on LDL and HDL cholesterol, click here.
Researchers are discovering evidence suggesting additional uses for statins. For example, statins may help to prevent some types of stroke.
How Do Statins Work?
Statins block an enzyme that causes the liver to produce cholesterol, thereby preventing excess amounts of cholesterol from entering the bloodstream.
Researchers are identifying additional ways that statins protect the heart and blood vessels. Statins have antioxidant properties. (An antioxidant helps to prevent deterioration by the action of oxygen.) By preventing oxidation of LDL cholesterol, statins decrease plaque formation. Statins also have anti-inflammatory properties; they reduce inflammation in plaques, preventing plaques from rupturing and forming clots that can lead to a heart attack. Statins also act on platelets and other clotting factors to reduce clot formation.
Should I Use Statins?
To answer this question, first consider your health history. You should probably take a statin if you:
- Are diagnosed with a heart disease, especially coronary artery disease
- Have already experienced a heart attack
If you do not have heart disease, consider your risk-factor profile. Certain risk factors increase your chances of developing heart disease. These include:
- Having diabetes
- Cigarette smoking
- Hypertension (defined as blood pressure of 140/90 or more)
- Family history of coronary heart disease (whether you have had a mother, father, sister, brother, daughter or son with heart disease)
- A low HDL-cholesterol level (under 40 mg/dl)
- Your age (men over 45 and women over 55 have a higher risk)
- Elevated C reactive protein level
The more risk factors you have in association with an elevated cholesterol level, the greater your need for a statin.
For example, consider two 50-year-old men, both with an LDL-cholesterol level of 130 mg/dl. The first man smokes, has high blood pressure, a family history of heart disease, and an HDL cholesterol level less than 40 mg/dl. The second doesn't smoke, has normal blood pressure, no family history of heart disease, and an HDL-cholesterol level greater than 60 mg/dl. The first man is a likely candidate for statin therapy and the second man is not, even though they both have the same LDL cholesterol level.
If you have known heart disease you should be on a statin; the more risk factors you have, the more you need to consider taking one.
What Are the Side Effects?
Serious side effects are uncommon. You may notice some mild abdominal discomfort and bowel irregularity. Usually, these symptoms fade as your body adjusts to statin therapy. Although rare, liver toxicity can occur. If you have underlying liver disease, your liver function may need to be monitored. Also rare are achy, tender muscles (a condition called myositis). If you experience muscle soreness, pain and weakness, you may need to stop taking the drug and undergo a muscle enzyme blood test.
People on high-dose statins may have an increased risk of developing type 2 diabetes. However, there is no proof that statins cause the disease. Studies have shown that a greater number of people taking a statin appear to develop higher than normal blood sugars compared to those not on a statin.
People with diabetes who take a statin should not stop the drug even if it does elevate their blood sugars a bit. Statins dramatically decrease their higher than average risk of heart disease, heart attack, stroke and premature death. Any increase in blood sugar can be handled by dietary changes, more exercise and a little more diabetes medicine if necessary.
Rarely, people taking a statin have reported a sudden loss of memory called transient global amnesia. This is a temporary inability to remember anything that happened over several hours to a couple days. With so many people taking statins, it's impossible to know if the statin should be blamed.
So far, there is no evidence that statins cause any permanent, long-term thinking or memory problems. And multiple studies looking at any relationship between dementia and statins suggest the opposite. Most studies show a lower risk of dementia in people taking a statin.
To prevent dangerous drug interactions, let your doctor know about any other drugs you are taking, including prescription and over-the-counter drugs and herbal remedies. Erythromycin and clarithromycin (Biaxin), two commonly prescribed antibiotics, can increase the risk of statin-induced myositis. People taking the anticoagulant warfarin will likely need more frequent blood tests to be sure that the right level of anticoagulation is being maintained.
What Are Guidelines for Taking Statins?
Most likely, you will take one pill per day, at your evening meal or at bedtime. Because your body manufactures more cholesterol at night than during the day, try to take the statin drug in the evening. If you miss a dose, don't double up the next day; simply return to your usual regimen.
It usually takes a few weeks to see results from statin therapy. After about six to eight weeks, expect your doctor to measure your LDL cholesterol.
If I Can't Take a Statin, What Are My Alternatives?
If you cannot tolerate statins, other medications are available that may help lower cholesterol levels.
- Niacin lowers total cholesterol, LDL cholesterol and triglyceride levels, and it raises HDL-cholesterol levels (the good cholesterol). Unfortunately, niacin is poorly tolerated by most people. Niacin may be sold under the trade names Niac, Niacor or Slo-Niacin.
- Fibrates can help lower triglyceride levels. (Triglycerides are lipids that circulate in your blood.) Fibrates also raise levels of HDL cholesterol (the good cholesterol). Some common fibrates are clofibrate (Atromid), gemfibrozil (Lopid), and fenofibrate (Tricor)
- Bile-acid sequestrants lower LDL-cholesterol levels. However, these drugs are rarely used because they lower HDL-cholesterol levels and cause constipation. Common bile-acid sequestrants include cholestyramine (Questran) and colestipol (Colestid).
- Cholesterol absorption blockers such as ezetimibe (Zetia) can help lower cholesterol levels, especially when used with a statin. However, it's unclear if ezetimibe improves outcomes for people with cardiovascular disease.
Regardless of whether you take cholesterol-lowering drug therapy, lifestyle changes are key to preventing heart disease. These changes include avoiding trans fats, deceasing intake of saturated fat and cholesterol, increasing physical activity and controlling weight. For information on how to maintain a heart healthy diet, click here.
What Is the Next Step?
If you have heart disease and are not taking statins, talk to your doctor about being prescribed these drugs. If you do not have heart disease, ask your doctor about undergoing a complete lipid profile. You should know the numbers for your total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels. Discuss with your doctor whether lifestyle changes are sufficient to maintain desirable cholesterol levels and cardiac health or whether you should consider statin therapy.