Statins are a group of drugs that can lower blood cholesterol levels. They do this by blocking an enzyme in the liver that is necessary for making cholesterol.
Cholesterol plays a role in normal cell and body function. However, very high levels can lead to atherosclerosis. This causes cholesterol-containing plaques to build up in the arteries and block blood flow.
Researchers estimate that nearly 30% of people aged 40 and over in the United States take some form of statin. Below, 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 (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor)
- pitavastatin (Livalo, Livazo)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor)
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.
People who are taking simvastatin, atorvastatin, or lovastatin should avoid grapefruit and grapefruit juice to reduce the risk of an interaction.
Most people who take statins have minor side effects, if any. Minor side effects can include:
The two most serious side effects are liver failure and skeletal muscle damage. These are rare.
Specifically, statins may lead to muscle damage in 1 in 10,000 people who take this type of drug each year. The damage is typically reversible once the person stops taking the statin.
More rarely still, a severe type of muscle damage called rhabdomyolysis may occur, in an estimated 2–3 in 100,000 people taking this type of drug per year.
Finally, statins may be linked with memory problems, though the evidence has been mixed. According to a 2018 review, statins may cause temporary memory impairment, but they may also have a protective effect against age-related cognitive decline. Research into this is ongoing.
What is 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.
Before prescribing a statin to anyone with liver disease, a doctor should thoroughly discuss the risks and possible benefits.
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.
People who are pregnant, breastfeeding, or intending to become pregnant should not take statins.
It is typically not safe to combine statins with:
- erythromycin, an antibiotic
- clarithromycin (Biaxin), another antibiotic
- itraconazole, an antifungal medication
- diltiazem (Cardizem), a drug often used to treat high blood pressure, angina, or arrhythmias
- verapamil, a drug often used for similar purposes
- fibrate drugs, which also lower LDL cholesterol levels
- protease inhibitors, a treatment for AIDS
Statins inhibit an enzyme called HMG-CoA reductase, which controls cholesterol production in the liver. The medicine blocks the enzyme, thereby slowing down the cholesterol production process.
Statins typically work well and can reduce LDL cholesterol by around 30% — or even 50%, with a high dosage.
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 recommend statins:
- a person has peripheral arterial 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 aged 40–75 with diabetes
- if the reading is 70 mg/dl or higher in people aged 40–75 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 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.