Statins: What to Know about the Cholesterol Drug

HHigh cholesterol is a prime example of having too much of a good thing. Our bodies naturally produce this substance in the liver and transport it throughout the body for various functions, including hormone regulation, cellular tissue regeneration, and vitamin absorption. When the system is working well, cholesterol can improve overall health. But when a certain type called low-density lipoprotein – LDL, sometimes dubbed the “bad” type – is produced in excess, it not only blocks the “good” type called high-density lipoprotein (HDL), it can also start to break down. accumulate in the arteries and form thick, hard deposits. This reduces the space for blood flow and increases the risk of blood clots, which can lead to a heart attack or stroke. The U.S. Centers for Disease Control and Prevention (CDC) notes that about 93 million American adults have high cholesterol, which represents about 36% of the U.S. adult population.

High cholesterol rarely has symptoms in its early stages, which is why knowing your cholesterol levels and lowering your LDL if it’s getting too high is crucial to heart health. For many people, a type of medication known as a statin may be a recommended step towards preventing cardiovascular risk. First approved by the U.S. Food and Drug Administration in 1985, these drugs block a substance your body uses to make cholesterol, which can lower your LDL cholesterol level and also help stabilize plaque in your blood vessels so it doesn’t build up. break. and become problematic.

According to the CDC, statin use has grown over the past decade, and nearly 39 million Americans take statins daily. Use increases after age 40, as cardiac risks tend to increase as we age. However, a statin prescription is not a guarantee for everyone.

Here are answers to five key questions about this common medication, along with advice on when to speak with your doctor.

How do statins work?

Much like slowing down production in a factory, statins work by reducing the amount of cholesterol produced by the liver. They also help the liver to remove cholesterol already in the blood, which can reduce the chances of you developing deposits in the arteries.

This differs from other types of cholesterol-lowering drugs because, rather than trying to get rid of excess cholesterol once it’s manufactured, statins target the source of cholesterol production.

For example, injectable drugs called PCSK9 inhibitors lower cholesterol by blocking LDL receptors in the body, resulting in how much cholesterol circulates in the bloodstream. There’s also niacin, sometimes called nicotinic acid, which works by raising HDL cholesterol levels – an action that lowers LDL cholesterol as a result.

See more information: What to know about high cholesterol in children

Has thinking about who should receive statins changed in recent years?

As more statins become available — there are now seven options — and the use of these drugs increases, scientists’ understanding of cholesterol and heart disease has also evolved, says Dr. Adriana Quinones-Camacho, a cardiologist at NYU Langone in New York.

“The more we learn about heart disease and cholesterol, the more nuanced the recommendations become,” she notes. “In the past, total cholesterol level, and especially LDL, may have been the biggest consideration for statin use, but this is no longer the case.”

For example, age is an extremely important variable. Research published in the journal Clinical Epidemiology in 2016 suggests that the statin prescribing rate increased most for people aged 50 to 59, while decreasing slightly for ages 60 to 74.

Research over the past decade has also clarified the strong association between diabetes and heart disease, especially if one also has high cholesterol. If you have diabetes, you’re already twice as likely to have heart disease or stroke — and at a younger age — than someone without the condition. Additional factors like cholesterol and high blood pressure can make it much more likely that your doctor will suggest a statin, says Quinones-Camacho.

“As we have more data and evidence on the effect of cholesterol on the body, as well as research on these other variables, this gives us more information that we can use to tailor our statin recommendations for each individual patient,” she adds.

Would someone with high cholesterol automatically be a candidate for statins?

In August 2022, the US Preventive Services Task Force recommended that people ages 40 to 75 at high risk of cardiovascular disease consult a healthcare professional about taking a statin to prevent a first heart attack or stroke.

While high LDL and low HDL numbers are two of the main considerations when it comes to statin recommendations, they’re not the only ones, says Dr. Kevin Ferentz, chairman of the department of family medicine and chief physician at GBMC Health Partners Primary Care in Maryland.

“High cholesterol is just one factor in the development of heart disease,” he says. “Others – like smoking, high blood pressure and diabetes – also play a role.” A doctor will consider your age, general physical condition, family history of heart problems, and the presence of other chronic illnesses, adds Dr. Jennifer Wong, cardiologist and medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Central in California.

Combining all these factors is not done by intuition – there is a standardized risk calculator used by health professionals that looks at nine different factors and calculates the probability of developing heart disease in 10 years. In some cases, says Wong, this score can prompt people to make important lifestyle changes that can reduce their risk without the use of medication.

Most notably, quitting smoking is a huge benefit to cardiovascular health, which can lower LDL cholesterol on its own. When combined with healthy eating and regular exercise, it is possible for a patient to achieve better cholesterol levels in just a few months, while also improving blood pressure and diabetes symptoms, if any are present.

However, variables that can’t be changed — like genetics and age — may be more prominent and increase risk to the point where statins are advisable, says Wong. And one factor that almost always drives statin recommendations? Having a previous cardiac event.

“If someone has had a heart attack or stroke, they are very likely to be a candidate for statins, regardless of their cholesterol level,” she says. “If they also have hypertension or diabetes in addition to a cardiac event, they will almost certainly be advised to take statins.”

See more information: How to lower cholesterol naturally

What are the most prevalent side effects?

Considering that statins have been increasingly used for nearly 40 years, there’s a lot of data on side effects as well as the balance between reward and risk, says Ferentz. In general, statins tend to be well tolerated, and most people who take them do not experience side effects, especially if they are well monitored.

Some people starting statins have high blood sugar levels. For most people, this isn’t a concern, says Wong, but if you’re pre-diabetic and that slight elevation increases your risk of developing type 2 diabetes, it may require a change in treatment. However, she adds, the conversation with your doctor will center on whether the benefit of taking a statin might outweigh the risk.

Also, doctors typically check liver function before people start a statin and again annually. “Statins occasionally raise liver function concerns,” says Ferentz. In certain cases, such as if a patient has liver damage, statins can be discontinued completely and replaced with other medications.

The main side effect associated with statins is myopathy, a neuromuscular disease that causes muscle pain. Muscle symptoms associated with statins can include mild to moderate pain, fatigue, weakness, and night cramps, and can be confirmed with a blood test.

Research suggests that up to 25% of people who take statins experience some type of muscle problem. In rare cases, this can progress to more serious conditions such as rhabdomyolysis, in which damaged muscle tissues release compounds such as proteins and electrolytes into the blood, potentially affecting the kidneys and heart.

However, this only occurs if muscle soreness is left untreated, says Wong. Most people who are experiencing higher levels of discomfort and side effects can be switched to a different statin or even a non-statin cholesterol lowering option that can address muscle issues.

“Every medicine has side effects and statins are no exception,” adds Wong. While muscle pain is the most common complaint, she also hears about sleeping difficulties, digestive problems and dizziness. “In all these cases, we are fortunate to have multiple types of statins available,” she says. “So it’s easy to switch to one that works better. Sometimes just lowering the dosage can have a major effect.”

When should you speak with your doctor?

Even if you’re generally healthy — don’t have any other chronic conditions, eat healthily, don’t smoke, and exercise regularly — you could still have high cholesterol. Keep in mind that it rarely has symptoms. Checking cholesterol after age 40 is crucial, but Quinones-Camacho suggests knowing your numbers decades earlier as well.

Most likely, younger people will not be given statins, but having a baseline to monitor their cholesterol levels can help lower overall heart health risks.

Regardless of your age, talk to your doctor if you have a family history of heart disease. You’ll also want to stay on top of your cholesterol numbers if you smoke now or in the past, or if you have high blood pressure, diabetes, suboptimal nutrition, or sedentary behavior.

“In the end, like everything else in medicine, statin use comes down to what’s best for the individual,” says Quinones-Camacho. “Two people of the same age with the exact same cholesterol numbers can be managed very differently in terms of cholesterol-lowering plans.” As with everything in medicine, prevention is preferable to treatment. “So the sooner you talk to your doctor, the better.”

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Statins: What to Know about the Cholesterol Drug

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