How Do Statins Work?

If you have high cholesterol, it’s more than likely you have discussed lifestyle changes with your doctor. They may have suggested a healthy diet and regular exercise to improve your health. 

Unfortunately, diet and exercise do not always cure cholesterol levels alone; medication is sometimes needed to help. According to the Center for Disease Control (CDC), nearly 94 million adults in the United States age 20 or older have total cholesterol levels higher than 200 mg/dL. Of those 94 million, 28 million have total cholesterol levels reported higher than 240 mg/dL. 

Too much cholesterol can stick to the walls of your arteries, causing choking and even blocking them. This affects your blood flow and can lead to major health complications. 

Statin therapy can reduce the risk of heart disease, heart attack, stroke, and even death from cardiovascular disease by 25% or more. If you have high cholesterol, your doctor may prescribe statins to help you out.

In this article, I’ll cover how statins work, who should and shouldn’t take them, and risks and benefits.

How Statins Work

Statin drugs work by blocking a liver enzyme needed to produce cholesterol.

They do this by lowering low-density lipoprotein (LDL) cholesterol levels, which are sometimes called bad cholesterol. 

Instead, they raise high-density lipoprotein (HDL), sometimes called good cholesterol. Statins work to remove existing cholesterol in the bloodstream. 

Bringing your cholesterol levels into healthy alignment with statins can slow the formation of plaques in your arteries. Statins reduce the inflammation in your artery walls that can lead to blockages that damage your organs.

There are two main types of statin medication: low-intensity statins (including pravastatin and simvastatin) and high-intensity statins (such as atorvastatin and rosuvastatin). 

For most people, a low-intensity statin is effective in lowering cholesterol levels, but in some cases, your doctor may prescribe a high-intensity dose. Statin medication is one effective way you can lower your cholesterol.

Do’s and Don’ts of Taking Statins

Statin drugs only work for as long as you continue taking them. Be sure to follow the instructions given by your doctor and take your dosage exactly as prescribed.

Do’s

• Schedule a follow-up appointment with your doctor after eight weeks of taking your statins, as it usually takes about six weeks for the medicine to lower your cholesterol
• Quit smoking
• Eat a healthy, balanced diet rich in vegetables
• For starchy foods, choose whole-grain varieties
• Exercise regularly to maintain healthy body weight

Don’ts 

• Avoid saturated fats and high-cholesterol foods
• Don’t consume large quantities of grapefruit or grapefruit juice as it increases the  concentration of the drug in your bloodstream
• Avoid excess alcohol

Who Should and Shouldn’t Take Statins

Statins are a relatively safe medication for most individuals.

However, they are not recommended for some people who are:

• Over 80 years old
• Pregnant or nursing
• Have active or chronic liver disease as they can cause serious muscle problems
• Have conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS)
• Studies show that statins can increase the risk of diabetes, especially in higher doses and among those who have other risk factors for diabetes

Risks and Benefits

While practicing a healthy lifestyle and quitting smoking can prevent strokes and heart attacks, statins can decrease this risk further. 

However, statin therapy is not for everyone. They come with potential side effects and are not recommended for certain groups of people. 

Knowing how the medication will affect you as well as monitoring your side effects will determine which course of treatment is right for you. 

Your health care provider may prescribe any of the following statins:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol XL)
• Lovastatin (Altoprev)
• Pitavastatin (Livalo)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor, Ezallor)
• Simvastatin (Zocor, FloLipid)

Side Effects

Several potential side effects can be experienced from statins.

These include:

Muscle pain and damage: Muscle aches are one of the most common side effects in people taking statins. The pain can be a mild discomfort or more severe. It may present as tiredness, soreness, or weakness in your muscles and in some circumstances, it may make daily activities difficult. 

Statin-associated muscle symptoms (SAMS): SAMS is often the leading reason why people on statins cease taking the medication. However, studies have found that telling people that they may experience the potential side effect, SAMS is increasing the cases among those who report the side effect. This is known as the “nocebo” effect.

Liver damage: In some cases, statin use can increase enzyme levels that cause liver inflammation. If the increase is only mild, you can continue to take statins, but you should speak with your doctor about any liver issues you are experiencing or have experienced. Liver damage from statins is rare, but still possible.

Symptoms of liver damage include:

• Dark-colored urine
• Loss of appetite
• Pain in your upper abdomen 
• Unusual fatigue or weakness
• Yellowing of the skin or eyes

If you have any of the above symptoms, contact your doctor immediately. They may order an enzyme test before or shortly after taking the statin to determine if you are at risk of liver damage from the medication.

Mental fuzziness: In some cases, patients can experience confusion and memory loss while taking statins. 

Rhabdomyolysis: In extremely rare cases (a few cases per million of those taking statins) statin drugs can cause life-threatening muscle damage known as rhabdomyolysis. This condition can inflict severe muscle pain, liver damage, kidney failure and death. Rhabdomyolysis can occur when you take statins in combination with certain drugs or if you take a high dose of statins. 

Who is at Risk?

Those at higher risk of complications from taking statins include:

• Those taking other medications simultaneously
• People with kidney or liver disease
• People who have medical conditions including hypothyroidism or neuromuscular disorders such as amyotrophic lateral sclerosis (ALS)
• People with vaginas are more likely to report more serious side effects from statins than people with penises  
• People with smaller body frames
• The elderly over the age of 80 years old 
• Drinking too much alcohol can increase the risk of side effects

Ultimately, the benefits of statins far outweigh the risks, making them an effective treatment for people with high cholesterol. 

If you struggle with high cholesterol and lifestyle changes have not helped, consult with your health care provider to determine the right treatment plan for you.

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