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

Are there other options?

Statins effectively reduce "bad" cholesterol (LDL). But, because of genetic differences, the type or dose of statin or combination of statins with other cholesterol-lowering drugs 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 to 20 percent.
  • If you have both high LDL and high triglycerides, you may benefit from combining the statin with prescription niacin (Niaspan, Niacor) 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 your dose of statins may be lowered to less than 20 milligrams (mg).
  • If you have just high triglycerides, use of niacin (Niaspan, Niacor) 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 hasn't shown that the combination drugs lower cholesterol more than does taking niacin and a statin separately.

What if taking a statin doesn't lower your cholesterol?

If a statin doesn't help lower your cholesterol, your doctor may first suggest trying a different statin or increasing the dose of the statin you currently take. In some cases, one medication may simply not be effective and a different drug must be substituted.

Your doctor may also add other medications, or may suggest that you make more lifestyle changes to help lower your cholesterol.

What other benefits do statins have?

Researchers think statins may have benefits other than just lowering your cholesterol. 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 could reduce your 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.

Statins could also have benefits that help prevent diseases that aren't related to your heart health, although more research is necessary. Other benefits of statins could include a reduced risk of:

  • Arthritis and bone fractures
  • Some forms of cancer
  • Dementia and Alzheimer's disease
  • Kidney disease

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 every day, 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.

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References
  1. Rosenson RS. Lipid lowering with statins. http://www.uptodate.com/index. Accessed Dec. 16, 2009.
  2. Pignone M. Treatment of lipids (including hypercholesterolemia) in primary prevention. http://www.uptodate.com/index. Accessed Dec. 16, 2009.
  3. Rosenson RS. Treatment of lipids (including hypercholesterolemia) in secondary prevention. http://www.uptodate.com/index. Accessed Dec. 16, 2009.
  4. Miller ML, et al. Muscle injury associated with lipid lowering drugs. http://www.uptodate.com/index. Accessed Dec. 16, 2009.
  5. Sewright KA, et al. Statin myopathy: Incidence, risk factors and pathophysiology. Current Atherosclerosis Reports. 2007;9:389.
  6. Cholesterol-lowering drugs. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=163. Accessed Dec. 16, 2009.
  7. Rosenson RS. Treatment of drug-resistant hypercholesterolemia. http://www.uptodate.com/index. Accessed Dec. 16, 2009.
  8. Robinson JG. Models for describing relations among the various statin drugs, low-density lipoprotein cholesterol lowering, pleiotropic effects, and cardiovascular risk. Journal of the American College of Cardiology. 2008;101:1009.
  9. Liu PY, et al. Evidence for statin pleiotropy in humans. Circulation. 2009;119:131.
CL00010 Feb. 11, 2010

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