Statins: Are these cholesterol-lowering drugs right for you?

Should you be on a statin? These cholesterol-lowering drugs have benefits and risks. Find out whether your risk factors for heart disease make you a good candidate for statin therapy.

Statins, drugs that are used to lower cholesterol, are being touted as one of the wonder drugs of the 21st century. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques on your artery walls, helping prevent further blockage in your blood vessels. Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others.

Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What happens when you take a statin for decades? Can they help prevent other disease?

Here's some information to help you put information about statins into perspective as you weigh whether they're right for you.

Should I be on a statin?

Whether you need to be on a statin depends on your cholesterol level along with your other risk factors for cardiovascular disease. If you have high cholesterol, meaning your total cholesterol level is 240 milligrams per deciliter, or mg/dL, (6.22 millimoles per liter, or mmol/L) or higher, or your "bad" cholesterol (LDL) level is 130 mg/dL (3.68 mmol/L) or higher, the numbers alone won't tell you or your doctor the whole story.

High cholesterol is only one of a number of risk factors for heart attack and stroke. Before you're prescribed a statin, your cholesterol level is considered along with other factors including:

Family history of high cholesterol or cardiovascular disease
Lifestyle
Blood pressure
Age
General health
Presence of diabetes
Excess weight
Smoking
Peripheral vascular disease — narrowing of the arteries in your neck, arms or legs

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke is probably already low.

If your doctor decides you should take a statin, you and your doctor will have to decide what dose to take. Statins come in varied doses — from as low as 5 milligrams to as much as 80 milligrams, depending on the medication. If you need to decrease your LDL cholesterol significantly — by 50 percent or more, it's likely you'll be prescribed a higher dose of statins. If your LDL cholesterol isn't as high, you'll likely need a lower dose. Talk to your doctor if you have concerns about the amount of statins you're taking.

Lifestyle is still key for lowering cholesterol

Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. Quitting smoking, eating a healthy diet, getting daily activity and managing stress are examples of lifestyle changes that will improve cholesterol, and most all of the other risk factors for heart disease. In fact, lifestyle changes may have a greater impact on reducing risk of heart disease and stroke than does medication alone.

If you're following the recommended lifestyle behaviors but your cholesterol — particularly your low-density lipoprotein (LDL), or "bad" cholesterol — remains high, statins might be an option for you. Risk factors for heart disease and stroke are:

High cholesterol
High blood pressure
Diabetes
Excess weight
Family history of heart disease
Physical inactivity
Heavy alcohol use
Poor stress and anger management
Age
Smoking
Peripheral vascular disease — narrowing of the arteries in your neck, arms or legs

Consider statins a lifelong commitment

You may think that once your cholesterol goes down, you can stop taking medication. But, if your cholesterol levels have decreased as a result of taking a statin, you'll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.

The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may allow you to maintain low cholesterol without continuing to take the medication, but do so under your doctor's supervision.

The side effects of statins

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication. Side effects include:

Muscle and joint aches (most common)
Nausea
Diarrhea
Constipation

There are two potentially serious side effects of statins of which you need to be aware:

Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. If the increase is severe, you may need to stop taking it, which usually reverses the problem. If left unchecked, increased liver enzymes can lead to permanent liver damage. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin, increase the risk of liver problems even more in people who take statins. Because liver problems may develop without symptoms, people who take statins have their liver function tested periodically.
Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys. Certain drugs when taken with statins can increase the risk of rhabdomyolysis. These include gemfibrozil, erythromycin (Erythrocin), antifungal medications, nefazodone (Serzone), cyclosporine and niacin. If you take statins and have new muscle aching or tenderness, check with your doctor.

It's important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver or kidney disease. Also, check out whether statins interact with any other prescription or over-the-counter drugs or supplements you take.

Keep in mind that when you begin to take a statin, you'll most likely be on it for the rest of your life. Side effects are often minor, but if you experience them, you may want to talk to your doctor about decreasing your dose or trying a different statin. Don't stop taking a statin without talking to your doctor first.

Are there other options?

Statins effectively reduce bad cholesterol (LDL). But, because of genetic differences, the type or dose of statin each person takes can vary. For example:

If you are not able to lower your LDL to the desired goal using statin medication, your doctor may add ezetimibe (Zetia) to your treatment plan or switch to a combination ezetimibe and simvastatin medication (Vytorin). This combination will help drop your LDL level further, perhaps even another 15 percent to 20 percent. You may have heard reports that the combination medication of ezetimibe and simvastatin (together, these two medications are called Vytorin) is no more effective than taking simvastatin by itself. But, this small study didn't find any differences in death, hospitalization or heart attacks between the two medications. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.
If you have both high LDL and high triglycerides, you may benefit from combining the statin with niacin (Niaspan) or combining the statin with a fibric acid drug such as fenofibrate (TriCor) or gemfibrozil (Lopid). The risk of muscle problems is higher when these medications are paired, so to combat that risk, your dose of statins may be lowered to less than 20 mg.
If you have just high triglycerides, use of niacin (Niaspan) is very effective. Fibric acid agents (TriCor and Lopid) are another option. Fish oil (omega-3 fatty acid) supplements (Lovaza) in 2- to 4-gram doses also can help.
If your high-density lipoprotein (HDL) cholesterol is low, niacin might be the best choice to raise it. Fibric acids also are useful but less effective than niacin. Exercise and weight loss may help, as well.
If your doctor recommends niacin in addition to a statin, you might want to discuss taking a medication that combines both niacin and a statin, such as Simcor or Advicor. These medications can reduce the number of pills you have to take. However, that may be the only benefit. Research studies haven't yet shown that the combination drugs lower cholesterol more than does taking niacin and a statin separately.

In some cases, one medication may simply not be effective and a different drug must be substituted. For other people, lifestyle changes may be all that are needed to lower cholesterol.

What else can statins do?

High cholesterol affects all arteries, not just those in the heart. Its negative effects permeate the body, so it's likely that the benefits of lowering cholesterol might have widespread health benefits as well.

One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart, to blood vessels and organs throughout the body.

In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. Statins also help relax blood vessels, lowering blood pressure. In addition, statins have blood-thinning effects, reducing the risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.

Other benefits of statins could include:

Prevention of arthritis and bone fractures. Statins might help protect against osteoporosis, arthritis and bone fractures, but more research is needed to confirm this benefit.
Prevention of cancer. It's unclear whether statins might reduce your cancer risk. While some studies have suggested statins could reduce cancer risk, later studies haven't found a connection between statin use and reducing risk for breast, colon, prostate, respiratory, skin, or gastrointestinal cancers.
Reduction in the risk of dementia and Alzheimer's disease. Statins might help keep your brain healthy, but more research is needed.
Protection of the kidneys. Statins may help protect kidneys, through their effects on cholesterol and blood pressure and perhaps their ability to reduce inflammation.

Statins may also be helpful in controlling the body's immune system response after an organ transplant.

Weighing the risks and benefits of statins

When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

Do I have other risk factors for cardiovascular disease?
Am I willing and able to make lifestyle changes to improve my health?
Am I concerned about taking a pill everyday, perhaps for the rest of my life?
Am I concerned about statins' side effects or interactions with other drugs?

It's important to take into account not only your medical reasons for a decision, but also your personal values and concerns. Talk to your doctor about your total risk of cardiovascular disease and discuss how your lifestyle and preferences play a role in your decision about taking medication for high cholesterol.