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

Find out whether your risk factors for heart disease make you a good candidate for statin therapy. By Mayo Clinic Staff

Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks.

Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others. Lower cost generic versions of many statin medications are available.

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 statins help prevent other diseases?

Should you 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.

High cholesterol
If you have high cholesterol, meaning your total cholesterol level is 240 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L) or higher, or your low-density lipoprotein cholesterol (LDL, or "bad" cholesterol) level is 130 mg/dL (3.37 mmol/L) or higher, your doctor may recommend you begin to take a statin. But the numbers alone won't tell you or your doctor the whole story.

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low. High cholesterol is only one of a number of risk factors for heart attack and stroke.

Other risk factors
Before you're prescribed a statin, your cholesterol level is considered along with other risk factors for cardiovascular disease, including:

  • Family history of high cholesterol or cardiovascular disease
  • Inactive (sedentary) lifestyle
  • High blood pressure
  • Poor general health
  • Having diabetes
  • Overweight or obesity
  • Smoking
  • Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)

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. Lifestyle changes you should consider making include:

  • Quitting smoking
  • Eating a healthy diet that's low in fat, cholesterol and salt
  • Exercising 30 minutes a day on most days of the week
  • Managing stress

If you're following the recommended lifestyle behaviors but your cholesterol — particularly your low-density lipoprotein (LDL) cholesterol, the "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
  • Being overweight or obese
  • Family history of heart disease
  • Not exercising
  • Heavy alcohol use
  • Poor stress and anger management
  • Older age
  • Smoking
  • Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)

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 after you take 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 help you lower your cholesterol without continuing to take the medication, but don't make any changes to your lifestyle or medications without talking to your doctor first.

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.

Common, less serious side effects

  • Muscle and joint aches (most common)
  • Nausea
  • Diarrhea
  • Constipation

Potentially serious side effects

  • Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. Rarely, if the increase is severe, you may need to stop taking it. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin (Niacor, Niaspan), increase the risk of liver problems even more in people who take statins.

    Although liver problems are rare, your doctor will likely order a liver enzyme test before or shortly after you begin to take a statin. You shouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.

  • 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 (Lopid), erythromycin (Erythrocin), antifungal medications, nefazodone, cyclosporine (Restasis, Sandimmune) and niacin (Niacor, Niaspan). If you take statins and have new muscle aching or tenderness, check with your doctor.
  • Increased blood sugar or type 2 diabetes. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. The risk is small, but important enough that the Food and Drug Administration (FDA) requires a warning on statin labels regarding blood glucose levels and diabetes. Despite this possible connection between increased blood sugar and statin use, it's still safe for most people with high cholesterol, including diabetics, to take statins. Talk to your doctor if you have concerns.
  • Neurological side effects. Some researchers have studied whether statins could be linked to memory loss or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. While there's little evidence that statins can cause ALS, the FDA says some people who take statins have developed memory loss or confusion while taking statins. These side effects reverse once you stop taking the medication. Talk to your doctor if you experience memory loss or confusion. Don't stop taking your statin medication before talking to 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 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.

Mar. 13, 2012 See more In-depth