Key takeaways
- Statins are a group of medications that lower cholesterol levels and can make a significant impact in reducing the risk of individuals having a stroke or heart attack.
- Possible side effects of statin use include nausea, headaches, and rash.
- There are many different statins. A person can talk with their healthcare professional to decide on the best option for their circumstances.
Cholesterol plays a role in normal cell and body function. However, very high levels can lead to atherosclerosis, which occurs when cholesterol-containing plaques build up in the arteries and block blood flow.
By reducing blood cholesterol levels, statins also lower the risk of heart attacks, strokes, and chest pain, also called angina.
In this article, we describe the uses, risks, and possible benefits of these drugs.
Doctors typically prescribe statins to lower blood cholesterol levels. These drugs block the action of a liver enzyme that helps produce cholesterol. They are also known as HMG-CoA reductase inhibitors.
Statins can reduce the amount of low-density lipoprotein (LDL) cholesterol in the body. People sometimes refer to this type as “bad” cholesterol. Statins can also raise levels of high-density lipoprotein (HDL), or “good,” cholesterol.
In addition, statins can lower the amount of fats, called triglycerides, in the blood.
Types of statins include:
Atorvastatin and rosuvastatin are the most potent, while fluvastatin is the least.
Combination drugs are also available. For instance, Vytorin is a combination of simvastatin, which is a statin, and ezetimibe, a drug that reduces the absorption of dietary cholesterol.
Side effects from statin use are often minor. The most common side effect is minor muscle aches, which can often be relieved by switching to one of the many alternative statin remedies.
More uncommon minor side effects can include:
- pins-and-needles sensations
- bloating
- a rash
- a headache
- nausea
- abdominal pain
- diarrhea
People who are taking simvastatin, atorvastatin, or lovastatin should avoid grapefruit and grapefruit juice to reduce the risk of an interaction with the enzyme CYP3A.
If someone likes grapefruit, they should talk with a healthcare professional to change to a statin that does not interact with this enzyme.
The two most serious side effects are liver and skeletal muscle damage. These are rare.
Liver damage
Statin use can lead to mild liver damage, and in severe cases, failure. This is a
As such, healthcare providers routinely check lab work, including liver function testing, to monitor for this.
Muscle damage
Statin use may cause inflammation and damage in the muscles, although this is rare. In many cases, this will resolve when a person stops taking the medication.
If a patient feels they are having severe muscle aches, they should report them to their healthcare provider, who can check labwork for this condition.
In extremely rare cases, a person may experience a severe type of muscle damage called rhabdomyolysis.
Rhabdomyolysis initially causes muscle pain and can worsen to cause significant muscle breakdown or kidney failure. In rare cases, it can be fatal.
The condition is more common in people who take a statin in combination with another drug that carries rhabdomyolysis risk or raises the level of statin in the blood.
Next steps: Talking with your doctor
If side effects are causing distress or affecting daily life, it is important to discuss next steps with a healthcare professional. When attending an appointment, you may wish to discuss:
- reducing dosage
- switching to another cholesterol-lowering medication
- taking a break from, or ceasing statin therapy
- implementing lifestyle changes
Before prescribing a statin to anyone with liver disease, a doctor should thoroughly discuss the risks and possible benefits.
Progressive liver disease
If the liver disease is stable and chronic, taking a low dose statin may carry greater benefits than risks. If the liver disease is progressive, however, guidelines warn against using statins.
If liver disease develops while taking a statin, the person’s doctor may recommend reducing the dosage of the statin, switching statins, or stopping their use.
Pregnanacy
People who are pregnant, chestfeeding, or intending to become pregnant should not take statins.
Drug interactions
It is not safe to combine statins with itraconazole, an antifungal medication.
Other drugs may also interact with statins in some instances, but not all. It is important to discuss current medication regimens with a healthcare professional before and during statin use. Doctors can monitor a person’s response to statins and offer alternatives or dose changes if necessary.
- erythromycin, an antibiotic
- clarithromycin (Biaxin), another antibiotic
- diltiazem (Cardizem), a drug often used to treat high blood pressure, angina, or arrhythmias
- verapamil, a drug often used for similar purposes
- protease inhibitors, a treatment for AIDS
Statins inhibit an enzyme called HMG-CoA reductase, which controls cholesterol production in the liver. The medication blocks the enzyme, thereby slowing down the cholesterol production process.
People usually continue taking statins even after reaching their target cholesterol level to maintain the protection against atherosclerosis.
People usually take statins to reduce high cholesterol and prevent atherosclerosis, lowering the risk of heart disease in the process.
A doctor may
- for people with peripheral artery disease
- after a heart attack or stroke
- if a blood test gives an LDL cholesterol reading of 190 milligrams per deciliter (mg/dl) or higher
- if the reading is 70 mg/dl or higher in people ages 40 to 75 with diabetes
- if the reading is 70 mg/dl or higher in people ages 40 to 75 with a high risk of developing heart disease or a stroke
Atherosclerosis can develop and form plaques even when blood cholesterol levels are low. Statins may benefit people who already have atherosclerosis or have a high risk of developing it, even if they do not have high cholesterol levels.
Statins do not directly cause weight gain. However, some people gain weight when taking statins because they independently increase their caloric intake.
The rule of 7 is a general guideline for statin therapy, suggesting that for every doubling of statin dosage, LDL levels will decrease by approximately 7%.
People may stop taking statins for a number of reasons, such as real or perceived muscle pain, interactions with other medications, pregnancy, or because they feel as though they no longer need to take the medication.
Statins are a group of drugs that can reduce high cholesterol, lowering the risk of atherosclerosis and heart problems.
Statins typically cause mild side effects, if any, but these drugs can, rarely, cause significant, and even life threatening, adverse effects.
Discuss the risks and possible benefits of taking a statin thoroughly with the doctor.