Doctors prescribe statins to lower cholesterol. Here are upsides and downsides to consider when taking them.
Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), Pravachol (pravastatin), lovastatin (Mevachol), Lescol (fluvastatin), Altoprav (lovastatin), Livalo (pitavastatin)
Side Effects and What to Do About Them
Muscle Aches and Pains: Based on observational studies, as much as 15% of people taking statins experience muscle aches and pains. Although rare, some people on statins have experienced myositis (an inflammation of the muscles) and rhabdomyolysis (destruction of muscle cells), the latter which can result in potentially life-threatening kidney injury.
Zocor is thought to be more likely to cause muscle pain as a side effect at high doses, according to the Mayo Clinic. They suggest trying a different statin or taking a lower dose of one you are on, though the latter could mean less cholesterol-lowering efficacy.
If you experience muscle aches, talk to your doctor about trying a different statin, or discontinuing statin treatment and finding an alternative therapy.
How does Simvastatin (Statins) work? By Pharmacist Betty Huang
Diabetes: There is a risk of diabetes associated with statin use. A large Finnish study last year examined over 8,700 men without diabetes who were followed for 6 years. Those who had taken a statin had a 46% higher risk of developing type 2 diabetes than those who have never taken one. The authors say the reasons why are because statins can increase insulin resistance, and they also appear to inhibit the pancreas’ ability to secrete insulin.
Cancer: A study has suggested that women who are on statins for the long term are at a higher risk of developing breast cancer. Researchers at the Fred Hutchinson Cancer Research Center in Seattle found that older women who took statins for 10 or more years have double the risk of being diagnosed with invasive ductal carcinoma and invasive lobular carcinoma, two common types of breast cancer.
Elevated Liver Enzymes: This can be an indication of liver damage which can lead to rhabdomyolysis. Liver function tests should be conducted occasionally to make sure liver enzymes are not higher than normal. To avoid the elevation and improve lipid lowering outcomes, some clinicians chose to give statins in combination with fibrate (a drug that lowers triglycerides), cholesterol inhibitors or niacin.
Cognitive Effects: There have been anecdotal reports of cognitive issues associated with statins. A number of analyses have found there is no significant evidence that statin lead to dementia or mild cognitive impairment. In 2012, the FDA mandated that a warning be added to the labeling of statins of possible cognitive effects. If you experience memory loss or other negative cognitive effects after taking a statin, talk to your doctor immediately.
Taking a statin with a fibrate or niacin, which are also used to lower lipids in the blood, can increase the risk for rhabomyolysis. Eating grapefruit or drinking grapefruit juice can also impact how statins work, so should be avoided. There have also been reports of interactions between some statin and protease inhibitors, which are antiviral drugs used to treat HIV/AIDS and hepatitis.
Always discuss with your doctor or pharmacist all the medicines, herbal supplements and even vitamins you are taking to avoid drug interactions.
Effectiveness & Considerations
Once started, statins are normally taken for the rest of your life. Statins interact with many other medicines. We will all need more medicines as we age. When you can safely delay by a few years (or forever) a drug by alternate and healthy means, it will mean one less drug to possibly incur interactions.
More and more clinicians are avoiding prescribing statins to their patients because of the risks of muscle aches and pains and the belief that the drugs are not as effective as they seem. Also, despite the fact statins are often touted as having the additional benefit of improving cardiovascular outcomes, much research has found this is not the case.
Alternatives to Statins
In many cases, changes in diet and exercise can make more of a difference in reducing cholesterol levels than taking a drug.
Other medications to lower cholesterol include Zetia (ezetimibe), which works by limiting the absorption of cholesterol. However, Zetia is usually taken in combination with a statin. Prevalite (cholestyramine), Welchol (colesevelam) and Colestid (colestipol) help to lower cholesterol by indirectly binding directly to bile acid, which is used in digestion. As a result, your liver uses extra cholesterol to make more bile acid, which reduces cholesterol levels in the blood.
There are also indications that some foods and herbal remedies may help to naturally reduce lipids in the blood, though they should not be the only method used to keep cholesterol in check. According to the Mayo Clinic, they are: garlic, oat bran, artichoke, barley, sitostanol beta-sitosterol and blond psyllium.
How They Work (Method of Action)
Most cholesterol found in the blood is manufactured inside the body, rather than through diet. Statins, a lipid-lowering medication, work by blocking the activity of an enzyme known as HMG-CoA reductase, which is involved in the body’s production of cholesterol. By doing so, statins help block the making of cholesterol in the liver. When the liver stops making cholesterol, its level in the blood falls.
What Worked for You?
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MedShadow Coverage on Statins
How Do Statins Work? (healthline)