What are statins and how do they work. What are the main types of statins available. What are the common and uncommon side effects of statins. How do statins help prevent cardiovascular disease. When should statins be prescribed and what are the alternatives.

Understanding Statins: Cholesterol-Lowering Medications

Statins are a group of medications designed to lower cholesterol levels in the blood, particularly low-density lipoprotein (LDL) cholesterol, often referred to as “bad cholesterol”. These drugs work by reducing the production of LDL cholesterol in the liver, effectively decreasing overall cholesterol levels in the body.

How do statins function within the body? Statins inhibit an enzyme called HMG-CoA reductase, which plays a crucial role in cholesterol production. By blocking this enzyme, statins effectively reduce the amount of cholesterol synthesized by the liver, leading to lower blood cholesterol levels.

The Importance of Cholesterol Management

Why is managing cholesterol levels so important? High levels of LDL cholesterol can lead to a condition called atherosclerosis, where arteries become hardened and narrowed due to the buildup of fatty deposits. This can significantly increase the risk of cardiovascular disease (CVD), a leading cause of death worldwide.

What are the main types of cardiovascular disease associated with high cholesterol?

• Coronary heart disease
• Angina
• Heart attacks
• Strokes

When Are Statins Prescribed?

Doctors may recommend statins in two primary scenarios:

1. If a patient has been diagnosed with a form of cardiovascular disease
2. If a patient’s personal and family medical history suggests a high likelihood of developing CVD within the next 10 years, and lifestyle changes have not sufficiently reduced this risk

How do healthcare professionals assess CVD risk? They typically use risk calculators that take into account factors such as age, gender, blood pressure, cholesterol levels, smoking status, and family history of heart disease.

Statin Administration and Duration

How are statins typically taken? Statins are usually administered as tablets taken once daily. The specific time of day for taking the medication may vary depending on the type of statin prescribed. Some statins are more effective when taken in the evening, while others can be taken at any time of day.

Is statin therapy a lifelong commitment? In most cases, yes. Discontinuing statin therapy often results in cholesterol levels returning to their previous high levels. However, the duration of treatment should always be discussed with a healthcare provider.

Types of Statins Available

What are the main types of statins prescribed in the UK? There are five primary statins available by prescription:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Pravastatin (Lipostat)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

How do these different statins compare in terms of efficacy? While all statins work to lower cholesterol, they may vary in potency and specific effects. Atorvastatin and rosuvastatin are often considered more potent, while pravastatin and fluvastatin may have fewer drug interactions.

Common Side Effects of Statins

While many people tolerate statins well, some may experience side effects. What are the most common side effects associated with statin use?

• Headache
• Dizziness
• Nausea
• Fatigue or physical weakness
• Digestive system problems (constipation, diarrhea, indigestion)
• Muscle pain
• Sleep problems
• Low blood platelet count

How common are these side effects? The frequency of side effects can vary between individuals and different types of statins. It’s estimated that between 10-20% of people taking statins may experience muscle pain or weakness, while other side effects occur less frequently.

Managing Statin Side Effects

What should patients do if they experience side effects? It’s crucial to discuss any side effects with the healthcare provider managing the statin therapy. In some cases, adjusting the dosage or switching to a different type of statin may alleviate side effects while maintaining the cholesterol-lowering benefits.

Uncommon Side Effects and Risks

While less frequent, some patients may experience uncommon side effects. What are some of the less common side effects associated with statin use?

• Vomiting
• Memory problems
• Hair loss
• Pins and needles sensation
• Liver problems
• Inflammation of the pancreas (pancreatitis)

How rare are these side effects? While exact figures vary, these uncommon side effects typically occur in less than 1% of patients taking statins. However, it’s important to report any unusual symptoms to a healthcare provider promptly.

Statin-Associated Muscle Symptoms (SAMS)

What are Statin-Associated Muscle Symptoms (SAMS)? SAMS refer to muscle-related side effects that some patients experience while taking statins. These can range from mild muscle aches to more severe conditions like myopathy or rhabdomyolysis in rare cases.

How are SAMS managed? Management strategies may include reducing the statin dose, switching to a different statin, or in some cases, using alternative cholesterol-lowering medications. Coenzyme Q10 supplements are sometimes recommended, although their efficacy in reducing muscle symptoms is still debated.

Interactions and Precautions

Can statins interact with other medications or substances? Yes, statins can interact with various drugs and even some foods, potentially increasing the risk of side effects or reducing their effectiveness.

What are some important interactions to be aware of?

• Grapefruit juice can increase the concentration of some statins in the blood
• Certain antibiotics may increase the risk of muscle-related side effects
• Some blood thinners can interact with statins, potentially increasing bleeding risk
• Some HIV medications can affect statin metabolism

How can patients minimize the risk of interactions? It’s crucial to inform healthcare providers about all medications, supplements, and dietary habits when starting statin therapy. Always read the information leaflet provided with the medication and consult a healthcare professional if there are any concerns.

Special Considerations

Are there any groups that should exercise caution with statin use? Certain populations may need special consideration when it comes to statin therapy:

• Pregnant women or those planning to become pregnant
• Breastfeeding mothers
• People with liver disease
• Individuals with a history of muscle disorders
• Patients with kidney disease

How should these special cases be managed? In these situations, the potential benefits of statin therapy must be carefully weighed against the risks. Alternative cholesterol-lowering strategies may be considered, or close monitoring may be required if statin therapy is deemed necessary.

Alternatives to Statins

Are there alternatives to statin therapy for managing cholesterol? Yes, several alternative approaches can be considered, especially for those who cannot tolerate statins or prefer non-pharmaceutical options.

Lifestyle Modifications

What lifestyle changes can help lower cholesterol levels?

• Adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• Increasing physical activity and regular exercise
• Maintaining a healthy body weight
• Limiting alcohol consumption
• Quitting smoking

How effective are lifestyle changes in managing cholesterol? While individual results may vary, studies have shown that comprehensive lifestyle modifications can lead to significant reductions in LDL cholesterol levels, sometimes rivaling the effects of moderate-intensity statin therapy.

Non-Statin Medications

What other medications can be used to lower cholesterol?

• Ezetimibe: Reduces cholesterol absorption in the intestines
• Bile acid sequestrants: Bind to bile acids in the intestines, indirectly lowering cholesterol
• PCSK9 inhibitors: Injectable medications that dramatically lower LDL cholesterol
• Fibrates: Primarily used to lower triglycerides but may also have modest effects on LDL cholesterol

How do these alternatives compare to statins? While these medications can be effective, statins remain the first-line therapy for most patients due to their well-established efficacy and safety profile. Non-statin medications are often used in combination with statins or as alternatives when statins are not tolerated.

The Future of Cholesterol Management

What new developments are on the horizon for cholesterol management? Research in the field of lipid management continues to evolve, with several promising avenues being explored:

• Gene therapy approaches targeting specific genes involved in cholesterol metabolism
• RNA interference therapies that can dramatically lower LDL cholesterol levels with infrequent dosing
• Novel combinations of existing therapies to enhance efficacy and reduce side effects
• Personalized medicine approaches using genetic information to tailor cholesterol management strategies

How might these advancements change the landscape of cholesterol management? While statins are likely to remain a cornerstone of therapy, these new approaches may offer additional options for patients who don’t respond adequately to current treatments or who experience significant side effects.

The Importance of Ongoing Research

Why is continued research in cholesterol management crucial? Cardiovascular disease remains a leading cause of mortality worldwide, and while current therapies have made significant strides, there is still room for improvement. Ongoing research aims to develop more effective, safer, and more personalized approaches to managing cholesterol and reducing cardiovascular risk.

What role do clinical trials play in advancing cholesterol management? Clinical trials are essential for evaluating the safety and efficacy of new therapies, as well as for refining our understanding of how to best use existing treatments. Patients interested in contributing to this research should discuss potential clinical trial participation with their healthcare providers.

Statins – NHS

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.

LDL cholesterol is often referred to as “bad cholesterol”, and statins reduce the production of it inside the liver.

Why have I been offered statins?

Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels. It’s a very common cause of death in the UK.

The main types of CVD are:

• coronary heart disease – when the blood supply to the heart becomes restricted
• angina – chest pain caused by reduced blood flow to the heart muscles
• heart attacks – when the supply of blood to the heart is suddenly blocked
• stroke – when the supply of blood to the brain becomes blocked

A doctor may recommend taking statins if either:

• you have been diagnosed with a form of CVD
• your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk

Find out more about when statins may be recommended.

Taking statins

Statins come as tablets that are taken once a day.

For some types of statin it does not matter what time of day you take it, as long as you stick to the same time.

Some types of statin should be taken in the evening.

Check with your doctor whether there’s a particular time of day you should take your statin.

You usually have to continue taking statins for life because if you stop taking them, your cholesterol will return to a high level.

If you forget to take your dose, do not take an extra one to make up for it. Just take your next dose as usual the following day.

If you accidentally take too many statin tablets (more than your usual daily dose), contact a doctor or pharmacist for advice or call NHS 111.

Cautions and interactions

Statins can sometimes interact with other medicines, increasing the risk of serious side effects, such as muscle damage.

Some types of statin can also interact with grapefruit juice.

It’s very important to read the information leaflet that comes with your medicine to check if there are any interactions you should be aware of.

If in doubt, contact a GP or pharmacist for advice.

Find out more things to consider when taking statins.

Side effects of statins

Many people who take statins experience no or very few side effects. Others experience some side effects, but these are usually minor, such as diarrhoea, a headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if they’re offered to you.

The risks of any side effects also have to be balanced against the benefits of preventing serious problems. 

Find out more about the side effects of statins.

Alternatives to statins

If you’re at risk of developing CVD in the near future, your doctor will usually recommend lifestyle changes to reduce this risk before they suggest that you take statins.

Lifestyle changes that can reduce your cholesterol level and CVD risk include:

• eating a healthy, balanced diet
• exercising regularly
• maintaining a healthy weight
• limiting the amount of alcohol you drink
• stopping smoking

Statins may be recommended if these measures do not help.

Read more about treating high cholesterol and preventing CVD.

Types of statin

There are 5 types of statin available on prescription in the UK:

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• pravastatin (Lipostat)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

Page last reviewed: 03 October 2022
Next review due: 03 October 2025

Statins – Side effects – NHS

Like all medicines, statins can cause side effects. But most people tolerate them well and do not have any problems.

You should discuss the benefits and risks of taking statins with your doctor before you start taking the medicine.

If you are having problems with side effects, talk to the doctor in charge of your care. Your dose may need to be adjusted or you may need a different type of statin.

The main side effects of statins are listed here. Some of these will not necessarily apply to the specific statin you’re taking.

For details of the side effects of a particular statin, check the information leaflet that comes with your medicine.

Common side effects

Side effects can vary between different statins, but common side effects include:

• headache
• dizziness
• feeling sick
• feeling unusually tired or physically weak
• digestive system problems, such as constipation, diarrhoea, indigestion or farting
• muscle pain
• sleep problems
• low blood platelet count

Uncommon side effects

Uncommon side effects of statins include:

• being sick
• memory problems
• hair loss
• pins and needles
• inflammation of the liver (hepatitis), which can cause flu-like symptoms
• inflammation of the pancreas (pancreatitis), which can cause stomach pain
• skin problems, such as acne or an itchy red rash
• sexual problems, such as loss of libido (reduced sex drive) or erectile dysfunction

Rare side effects

Rare side effects of statins include:

• muscle weakness (myopathy)
• loss of sensation or tingling in the nerve endings of the hands and feet (peripheral neuropathy)
• tendon problems (tendons are tough cords of tissue that connect muscles to bones)

Muscle effects

Statins can rarely cause muscle inflammation (swelling) and damage. Speak to your doctor if you have muscle pain, tenderness or weakness that cannot be explained – for example, pain that is not caused by physical work.

Your doctor may carry out a blood test to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.

If the CK in your blood is raised, your doctor may advise you to stop taking the statin. Regular exercise can sometimes lead to a rise in CK, so tell your doctor if you’ve been exercising a lot.

Once your CK level has returned to normal, your doctor may suggest you start taking the statin again, but at a lower dose.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you’re taking.

It’s run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.

Page last reviewed: 03 October 2022
Next review due: 03 October 2025

Statins: pharmacological group

Statins (atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, fluvastatin) inhibit 3-hydroxy-3-methyl-glutaryl-CoA reductase, an enzyme involved in cholesterol synthesis, mainly in the liver. They are the most effective means of correcting hypercholesterolemia, as well as primary and secondary prevention of complications of atherosclerosis, reducing the incidence of myocardial infarction, stroke and coronary death.

Contraindications. Hypersensitivity, active liver disease, pregnancy (when using statins, women should use effective contraceptive methods), breast-feeding.

Warnings. Patients with a history of liver disease or alcohol abuse should be especially careful when taking statins. Prior to prescribing a statin, liver function should be assessed. Liver function tests and creatine kinase activity should be repeated 1–3 months after initiation of statin use and each dose increase, and then monitored at intervals of 6–12 months or more frequently if signs of liver or muscle damage appear. The use of the statin should be discontinued if the activity of ALT and ACT, when repeated, is 3 times the upper limit of normal. Patients should be actively questioned about the presence of muscle soreness or weakness in order to detect myopathy in a timely manner. If creatine kinase activity > 5 times the upper limit of normal and there are clinical manifestations of myopathy, you should stop taking the statin until the clinical manifestations completely disappear and creatine kinase activity normalizes. After that, therapy with the same statin at a lower dose should be resumed or another statin should be prescribed at the same minimum dose.

Side effects. Headache, changes in liver function tests, paresthesia, abdominal pain, flatulence, nausea, vomiting, diarrhea, constipation, allergic reactions; rarely – hepatitis.

Influence on muscles. Muscle involvement (myalgia, myositis and myopathy) occurs in 1-5% of statin therapy. The likelihood of developing myopathy increases with the use of statins in high doses, as well as when they are combined with fibrates, nicotinic acid, immunosuppressants, erythromycin, clarithromycin, azole antifungals, and with constant consumption of grapefruit juice. Therefore, if combination therapy is necessary, monitoring of enzyme activity (creatine kinase, ALT, ACT) should be carried out more often, and patients should be instructed about the possibility of developing myopathy and, in rare cases, rhabdomyolysis (muscle tissue breakdown).

Development of diabetes. There have been reports that long-term statin use may be associated with a higher risk of developing diabetes. It has been noted that high-dose statin use in individuals with low BMI, impaired glucose tolerance, the elderly, and females is associated with a slightly higher incidence of diabetes mellitus compared with moderate-dose statin use. However, the benefit of statins in reducing the risk of developing cardiovascular complications far outweighs the risk of developing diabetes.

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Statins – what is it, benefits and harms

Statins – what kind of medicine is it? Statins are drugs that lower blood cholesterol levels. Their main purpose is the primary prevention and treatment of diseases of the cardiovascular system, since cholesterol is one of the main factors provoking their occurrence and development.

Cholesterol is an organic alcohol naturally produced in the body, as well as ingested with food, and it can cause blockage of blood vessels, being deposited in them in the form of atherosclerotic plaques. This entails malnutrition of the brain and limbs, leads to a whole bunch of diseases in a person (ischemic heart disease, cerebrovascular insufficiency), and can even cause gangrene, stroke or heart attack.

In simple terms, what it is – these are drugs that prevent heart attacks and strokes, lower and maintain normal cholesterol levels by blocking its production by the body.

What are statins for cholesterol?

What are statins? Statins are all those drugs that inhibit cholesterol-producing enzymes in the liver. They can also improve the function and structure of the heart muscle, which is especially important in the prevention and recovery of myocardial infarction. These drugs belong to the lipid-lowering group of drugs – substances that are aimed at reducing the concentrations of certain harmful fractions in the body (to which cholesterol belongs).

How do statins work in the body?

To understand how statins lower cholesterol, it is worth explaining the mechanism of action. It lies in the fact that statins inhibit the enzyme HMG-CoA reductase, which is responsible for the synthesis of this compound. Here we get the answer to the question of why and why statins are harmful – their negative effect on the liver, which produces cholesterol.

What statins do next in the body: lower the concentration of cholesterol in the blood, and also increase the level of “good” cholesterol – HDL.

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At what cholesterol should one start taking statins?

At what cholesterol should I take statins? The normal level of total cholesterol in women is 2.9- 6 mmol / l, in men – 3.6 – 7.8 mmol / l. However, it is worth considering that it can change with age, as well as with some hormonal disruptions, so in any case, these drugs are prescribed by a doctor. He will explain at what time to take statins, how much to take statins. Also, when prescribing, he will separately consider the level of “bad” and “good” cholesterol in your body.

Don’t wonder at what age you take statins – the decision is made based on test results, not age. However, despite the safety of modern drugs, it is worth considering the possible risk for elderly patients – so the final decision should be made by the doctor.

Can I take statins every other day?

Why do people take statins at night? The answer is simple – the deposition of cholesterol on the walls of blood vessels, as well as thrombosis, is especially active at night, during sleep. Therefore, do not think about what time of day to take statins – just drink them before bedtime.

Speaking about how many years you can take statins, it is worth saying that they give a stable therapeutic effect only with constant and long-term use. When prescribed by a doctor, they can be drunk for 3-5 years and then, if necessary, continue taking them. Moreover, if indicated, they can be taken for a lifetime, and, with the right choice of the drug and the right dosage, even without pronounced side effects.

Statins: side effects on the body

Which latest generation statins are best for cholesterol? Speaking about specific names, it is worth mentioning such drugs as atorvastatin, cerivastatin, rosuvastatin, pitavastatin, fluvastatin and others. They may have different trade names – only generic international names of active substances are given here, by which you can easily find the right medicine. The benefits and harms of statins are the subject of much discussion, however, however, these drugs are modern, they have a minimum of side effects and contraindications.

However, here are the main possible side effects of statins that sometimes appear when taken:

• lower blood sugar levels
• insomnia
• obesity
• vomiting and diarrhea
• constipation
• diarrhea
• allergic reactions
• back and muscle pain

How to replace statins?

How to replace statins for lowering cholesterol is a topical issue for those who, due to contraindications or side effects, cannot take them. There is a whole list of folk remedies and products that can lower blood cholesterol levels.

There are other ways to lower cholesterol without statins. This is adequate physical activity, minimizing stress, full and sufficient sleep (at least 7-8 hours a day). You should give up bad habits – smoking, alcohol, put your diet in order by reducing the consumption of animal fats. If you have excess weight, you should get rid of it.

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