Statins (Cholesterol Lowering Drugs)

• Statins, also known as HMG-CoA reductase inhibitors, are effective cholesterol-lowering medications and increase clearance of low-density lipoprotein (LDL).
• The benefits of statin use decreases the risk of heart attack, stroke, and other arterial diseases that are related to high cholesterol levels in the body.
• The majority of physicians and researchers support the use of statins but there are some investigators that suggest they may be "overused".
• Cholesterol is a soft, waxy substance found in the blood and in all cell membranes; it is also used to form some hormones. It is an integral part of a normal person's body. Cholesterol can be absorbed from food and also synthesized in the liver.
• High levels of cholesterol in the blood is referred to as hypercholesterolemia. Hypercholesterolemia is a major risk factor for cardiac, stroke, and other diseases because high levels of cholesterol in the blood cause cholesterol to be deposited in arteries, which then forms plaque, and eventually may participate in artery blockage.
• Statins are not the only treatments used to lower cholesterol; for example, nicotinic acid, fibric acid, and cholesterol absorption inhibitors are prescribed to lower cholesterol levels.
• In addition to medication, risk modifiers to lower cholesterol include the following:
  • a balanced diet low in cholesterol and saturated fat;
  • increased physical activity,
  • smoking cessation; and
  • weight loss.
• Often, a health-care professional may ask the patient to try to modify these risks factors for a few months before prescribing the statin medication to see the impact of lifestyle changes on cholesterol, triglyceride, and other levels.
• Statins do not replace making positive lifestyle changes to lower blood cholesterol levels; they work together in decreasing cholesterol levels and results are usually seen after 4-6 weeks of taking statins.

Commonly prescribed statins include:

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• lovastatin (Mevacor, Altocor)
• pravastatin (Pravachol)
• pitavastatin (Livalo)
• simvastatin (Zocor)
• rosuvastatin (Crestor)

Statins come in tablet or capsule forms and are usually taken with the evening meal or at bedtime.

Statins may lower cholesterol levels by 20% to 60% by slowing the production of cholesterol and by increasing the liver's ability to remove LDL (low density lipoprotein) or bad cholesterol. Statins lower LDL levels more effectively than other types of drugs. They also modestly increase HDL (high-density lipoprotein) or good cholesterol levels and decrease total cholesterol and triglyceride levels.

Statins are safe and well tolerated; however, side effects may occur. They include:

• Muscle pain or soreness
• Leg pain
• Muscle weakness
• Generalized pain and weakness
• Vomiting
• Stomach cramps
• Brown discolored urine caused by breakdown of muscles cells being passed in the urine

These symptoms may suggest possible muscle problems such as myopathy and rhabdomyolysis. Rhabdomyolysis a in which the muscle cells break down and cause kidney failure. These symptoms may present a medical emergency and should not be ignored. You should stop taking the statin medication and contact your health-care professional immediately for advice. Liver inflammation may occur with statin use and often blood tests monitoring liver function are done on a routine basis.

Less serious side effects may include upset stomach, bloating and gas, constipation, and abdominal cramps. These symptoms are usually mild to moderate and generally disappear as the body adjusts to the medication.

Other side effects associated with statins include:

• Diarrhea
• Joint pain
• Cold symptoms
• Insomnia
• Urinary tract infections
• Nausea
• Increased liver enzymes

Grapefruit juice may decrease the ability of the liver to metabolize some statins, for example, atorvastatin (Lipitor), simvastatin (Zocor), and lovastatin (Mevacor, Altocor), and should not be consumed at the same time as the statin medication is taken. Some doctors recommend avoiding any grapefruit juice. Also, and possibly more importantly, tell your doctor about any prescription and nonprescription medications you are taking.

Statins have been associated with increased fasting blood glucose (blood sugar) levels, HbA1C, and diabetes.

Statins have been associated with memory loss, forgetfulness, amnesia, memory impairment, and confusion. Memory loss and other cognitive side effects are rare side effects of statins and they are not serious. Symptoms may begin 1 day to years after stating the statin and resolve within a median time of 3 weeks after the statin is stopped.

Statins and other medications may interact, causing serious side effects. These can include the following:

• over-the-counter vitamins and dietary and herbal supplements;
• cholesterol lowering medications such as fibrates or nicotinic acid;
• certain antibiotics;
• birth control medications;
• warfarin (Coumadin), a blood thinner (the combination of statins and warfarin may cause blood to become too thin);
• medications to treat HIV/AIDS; and
• medications used to suppress the immune system.

Health-care professionals or pharmacists will be able to give advice and direction regarding potential interactions between statins and other medications and dietary supplements.

Individuals should not use statins if they:

• Are allergic to statins or their ingredients
• Are pregnant or planning a pregnancy
• Are breastfeeding
• Have active liver disease.
• Drink excessive amounts of alcohol or are an alcoholic
• Have a history of myopathy (a type of muscle disease).
• Have renal failure due to rhabdomyolysis