Alternative medicine (3)
- Red yeast rice (Monascus purpureus)
- Cholesterol-lowering supplements: Lower your numbers without prescription medication
- Herbal supplements may not mix with heart medicines
- Membranous nephropathy
- Cholesterol levels: What numbers should you aim for?
- Triglycerides: Why do they matter?
Lifestyle and home remedies (8)
- Top 5 lifestyle changes to reduce cholesterol
- HDL cholesterol: How to boost your 'good' cholesterol
- Cholesterol: Top 5 foods to lower your numbers
- see all in Lifestyle and home remedies
- Tool: Target heart rate calculator
Tests and diagnosis (2)
- Cholesterol levels: What numbers should you aim for?
- Cholesterol test
Treatments and drugs (5)
- Niacin to boost your HDL, 'good,' cholesterol
- Statins: Are these cholesterol-lowering drugs right for you?
- Lowering cholesterol: Discover your options
- see all in Treatments and drugs
Statins: Are these cholesterol-lowering drugs right for you?
Are there other options?
Statins effectively reduce LDL cholesterol. 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, Fenoglide, Lipofen) 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.
- 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 acids) supplements (Lovaza) in 2- to 4-gram doses also can help.
- If your high-density lipoprotein (HDL) cholesterol is low, your doctor might prescribe niacin to raise it, especially if your LDL cholesterol remains high despite taking other medications. 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 a combination drug lowers cholesterol more than does taking niacin and a statin separately.
You may have heard that a large study that examined the effect of niacin to raise HDL cholesterol was stopped early. This study examined how niacin worked when used with statin medications for people who have a history of heart disease. The trial was stopped because no difference was seen between people who took prescription-strength niacin and people who took a placebo. The study also found there may be a small increase in the risk of stroke for people who take niacin to increase their HDL cholesterol level. More research is necessary to see how effective niacin might be compared with other heart disease medications. You shouldn't stop taking niacin unless you get your doctor's OK. Talk to your doctor if you're concerned about taking niacin.
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?
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.Previous page
(2 of 2)
- Rosenson RS. Statins: Actions, side effects, and administration. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- Pignone M. Treatment of lipids (including hypercholesterolemia) in primary prevention. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- Rosenson RS. Treatment of lipids (including hypercholesterolemia) in secondary prevention. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- Rosenson RS, et al. Muscle injury associated with lipid lowering drugs. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- Mammen AL, et al. Statin myopathy: A review of recent progress. Current Opinion in Rheumatology. 2010;22:644.
- Harper CR, et al. Evidence-based management of statin myopathy. Current Atherosclerosis Reports. 2010;12:322.
- Drug therapy for cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp. Accessed Jan. 5, 2012.
- Rosenson RS. Treatment of drug-resistant hypercholesterolemia. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- 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.
- Liu PY, et al. Evidence for statin pleiotropy in humans. Circulation. 2009;119:131.
- Rosenson RS. Statins: Possible noncardiovascular benefits. http://www.uptodate.com/index. Accessed Jan. 5, 2012.
- FDA statement on the AIM-HIGH trial. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm256841.htm. Accessed Jan. 24, 2012.
- Your guide to a healthy heart. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.pdf. Accessed Jan. 25, 2012.
- FDA announces safety changes in labeling for some cholesterol-lowering drugs. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm. Accessed Feb. 28, 2012.
- Culver AL, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Archives of Internal Medicine. 2012;172:144.