The More You Know: Statins

Adegbenga B. Ademolu, MBBS
doctor taking blood pressure of patient

Statins are a group of drugs prescribed by your doctor to lower the level of cholesterol in your blood. Cholesterol is a waxy, fat-like substance in your body’s cells that may be dangerous to your body’s system at high, unchecked levels in the blood. Examples of statins approved by the United States Food and Drug Administration (FDA) and their commonly known names in the pharmaceutical industry are atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor), simvastatin (Zocor), and pitavastatin (Livalo, Zypitamag).

Your doctor may place you on statins to prevent damage to the arteries that circulate blood throughout your body and the development of heart disease, even if you don’t yet have evidence of such disease.

Among the conditions for which your doctor will place you on a statin is diabetes mellitus. Over time, diabetes is associated with abnormalities in your cholesterol levels that can hasten the rate of damage to your system. High cholesterol in your blood can block arteries by forming a substance called plaque that can stick to the walls of your arteries. Plaque can block the normal smooth transit of your blood along the arteries that convey blood to different parts of your body, thereby causing problems similar to the way that traffic jams do. The problems caused by this blood transit disturbance depend on the type of artery it blocks and the part of your body to which the artery transports blood. Cholesterol can cause a heart attack if it blocks an artery that supplies blood to the heart and can cause a stroke if it blocks an artery leading to the brain. The possibility of these dangers is increased if a heart attack had affected your sibling, father, or mother. Using statins to prevent such conditions is beneficial.

"Your doctor may place you on statins to prevent damage to the arteries that circulate blood throughout your body and the development of heart disease, even if you don’t yet have evidence of such disease."

Hypertension (high blood pressure) together with high cholesterol can lead to diseases like heart attack and stroke more quickly than either hypertension or high cholesterol alone. To reduce this risk, statins are used to lower the cholesterol level, particularly in people with obesity and high cholesterol. However, al-though the prevalence of obesity has increased among Americans as well as in virtually all other ethnic groups throughout the world, the presence of obesity itself does not signal the use of statins. Obesity—whether in the trunk, abdominal area, throughout the body, or around major organs like the heart or liver—does not automatically indicate high cholesterol or statin use. If you are obese and your doctor did not place you on statins, discuss it with your doctor and ask whether you have normal cholesterol.

Metabolic syndrome is another reason for using statins, because metabolic syndrome increases the likelihood of developing heart disease, diabetes, and stroke. Also, some individuals are born with a condition (familial hyperlipidemia or hypercholesterolemia) that causes their blood lipids (blood fat) to be much higher than in the average American. Such disease conditions run in their family and, therefore, statin use is often common in their family as well.

Like most drugs, statins have some undesirable effects. Statins can cause muscle aches and joint pain, particularly in elderly patients. If these symptoms occur, discuss them with your doctor, because stopping the statins may ameliorate these complaints. Statins may also cause liver damage, although this is rare. Statins are also known to cause increases in your blood glucose level. Although accidentally taking an overdose of statins probably is not dangerous, it should be reported to your doctor.

If you are using other drugs with statins, there may be an interaction between the statins and the other drugs that increase or reduce the effects of the other drugs. Always let your doctor know the other drugs you are taking before starting statins, in case you need to substitute an alternative drug. Heavy alcohol consumption also affects the way statins work in the body and how they are excreted.

In most cases, the use of statins requires a lifelong commitment to control your cholesterol level. However, particularly if damage your liver nears a dangerous level, your doctor may advise you to stop the statin for a drug holiday so that your liver can recover from the undesirable effects of the statin.

Women are advised not to take statins while pregnant or when trying to conceive, as statins may be harmful to their unborn baby. Breastfeeding mothers are also advised against taking statins. People who have abnormal cholesterol as an inherited problem (familial hypercholesterolemia) who are breastfeeding should stop breastfeeding prior to statin use.

Statins are generally taken by mouth once a day and usually at night, when your body produces less cholesterol. When you use statins, avoid ingesting large quantities of grapefruit juice (ie, ≥1 quart/day). The good news about statins is that they are cost effective and have Medicare and Medicaid coverage.