What are Statins?

Statins are a group of drugs prescribed to lower cholesterol, protect against damage from coronary-artery disease and prevent heart attack.

Statins are extremely effective in decreasing heart disease and preventing death. In terms of providing health benefits to a broad segment of the population, statins may be the most important drugs to emerge in recent times. Commonly prescribed statins include lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), and Atorvastatin (Lipitor).

Statins provide the greatest benefit to people with:

• Heart disease
• Diabetes
• High cholesterol levels and other risk factors for heart disease.

Keep in mind that you don't have to be a heart patient to benefit from statins. Indeed, statins may even have benefits for people with moderate cholesterol levels, as long as they are at an increased risk of heart disease. These high risk factors include diabetes, cigarette smoking, high blood pressure, and family history of early onset coronary heart disease. You need to be aware of your own personal cardiac-risk profile to decide if you may benefit from this remarkable group of drugs.

How do statins work?

Statins block an enzyme that causes the liver to produce cholesterol, thereby preventing excess amounts of cholesterol from entering the bloodstream.

Researchers are identifying additional ways that statins protect the heart and blood vessels. Statins have antioxidant properties (An antioxidant helps to prevent deterioration by the action of oxygen). By preventing oxidation of LDL cholesterol, statins decrease plaque formation. Statins also have anti-inflammatory properties; they reduce inflammation in plaques, preventing plaques from rupturing and forming clots that can lead to a heart attack. Statins also act on platelets and other clotting factors to reduce clot formation.

Are there disadvantages of taking stains?

Disadvantages of taking statins appear relatively minor. Serious side effects are uncommon. Rarely, you may experience an upset stomach, gas, constipation and abdominal pain or cramps. Usually, these symptoms fade as your body adjusts to statin therapy. Although rare, liver toxicity can occur. If you have underlying liver disease, your liver function may need to be monitored. Also rare are achy, tender muscles (a condition called myositis). If you experience muscle soreness, pain and weakness, you may need to stop taking the drug and undergo a muscle enzyme blood test.

Should I take statins?

To answer this question, first consider your health history. You should probably take a statin if you:

•  Are you diagnosed with a heart disease, especially coronary artery disease?
Have already experienced a heart attack?
Have diabetes?

If you do not have heart disease or diabetes, consider your risk-factor profile. Certain risk factors increase your chances of developing heart disease. These include:

•  Cigarette smoking
Hypertension (defined as blood pressure of 140/90 or more)
Family history of coronary heart disease (whether you have had a mother, father, sister, brother, daughter or son with heart disease)
A low HDL-cholesterol level (under 40 mg/dl)
Your age (men over 45 and women over 55 have a higher risk)
Elevated C reactive protein level

The more risk factors you have in association with an elevated cholesterol level, the greater your need for a statin: For example, consider two 50-year-old men, both with an LDL-cholesterol level of 130 mg/dl. The first man smokes, has high blood pressure, a family history of heart disease, and an HDL cholesterol level less than 40 mg/dl. The second doesn't smoke, has normal blood pressure, no family history of heart disease, and an HDL-cholesterol level greater than 60 mg/dl. The first man is a likely candidate for statin therapy and the second man is not, even though they both have the same LDL cholesterol level.

What are the guidelines for taking statins?

Most likely, you will take one pill per day, at your evening meal or at bedtime. Because your body manufactures more cholesterol at night than during the day, taking statin drugs in the evening is key. If you miss a dose, don't double up the next day; simply return to your usual regimen.

Expect to wait several weeks before seeing results from statin therapy. After about six to eight weeks, expect your doctor to measure your LDL cholesterol. This measurement will be averaged with a second measurement of LDL cholesterol to determine if any changes to your regimen are necessary.

If I can't take a statin, what are my alternatives?

If you cannot tolerate statins, other medications are available that may help lower cholesterol levels:

Niacin lowers total cholesterol, LDL cholesterol and triglyceride levels, and it raises HDL-cholesterol levels (the good cholesterol). Unfortunately, niacin is poorly tolerated by most people. Niacin may be sold under the trade names Niac, Niacor or Slo-Niacin.

Fibrates can help lower triglyceride levels. (Triglycerides are lipids that circulate in your blood.) They also raise levels of HDL cholesterol (the good cholesterol). Some common fibrates are clofibrate (Atromid), gemfibrozil (Lopid), and fenofibrate (Tricor)

Bile-acid sequestrants lower LDL-cholesterol levels. However, these drugs are rarely used because they lower HDL-cholesterol levels and cause constipation. Common bile-acid sequestrants include cholestyramine (Questran) and colestipol (Colestid).

Cholesterol absorption blockers such as the new drug Zetia can help lower cholesterol levels, especially when used with a statin. Regardless of whether you take cholesterol-lowering drug therapy, lifestyle changes are key to preventing heart disease. These changes include deceased intake of saturated fat and cholesterol, increased physical activity and weight control.

What is the next step?

Talk to your doctor about being on statins if you have heart disease or diabetes and are not taking statins. If you do not have heart disease or diabetes, your doctor about undergoing a complete lipid profile (you should know the numbers for your total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride). Discuss with your doctor whether lifestyle changes are sufficient to maintain desirable cholesterol levels and cardiac health or whether you should consider statin therapy.
Ramiro Antuña de Alaiz
Education Treatment Unit
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