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.

Mar. 13, 2012 See more In-depth