You may have heard a lot about statins lately from the many ads on TV or from your social media. If you have high cholesterol, your physician may have even prescribed a statin to you.
Statins can help lower cholesterol and reduce the risk of heart attacks, stroke and other heart and vascular problems. But they aren’t right for all patients, and they can rarely cause side effects.
If you’re thinking about whether you should take statins, talk to your physician. They can run tests and help you weigh any possible risks with the benefits.
In the meantime, Melissa Tracy, MD, a cardiologist at RUSH, helped answer some of patients’ most frequently asked questions about statins. These answers can help direct your conversation with your doctor.
1. What are statins? What do they do?
Statins are tablets that are used to reduce your low-density cholesterol, also called LDL cholesterol or “bad” cholesterol. They can also have an anti-inflammatory effect and may help lower blood pressure.
The goal in taking statins is to lower your risks for cardiovascular problems like heart attacks, clogged arteries and strokes.
LDL cholesterol can build up, or calcify, leading to narrowed or hardened arteries. While statins can’t remove this calcification, they can prevent or delay it from worsening.
You’ll need a prescription from a physician to get statins. Most people who start taking them must stay on them for life, even if their LDL cholesterol goes down.
“I have had some patients that I can get off of a statin, but it tends to be one of those agents that we use lifelong,” Tracy says.
You may also need to stop taking statins if you go through changes in liver function, pregnancy, menopause or other health changes.
There are many different types of statins that can vary in strength, and they can either be generic or brand name. Some of the most common include atorvastatin, which can go by the brand name Lipitor, and rosuvastatin, also known by the brand name Crestor.
These medications have come a long way since they were first introduced and used to reduce cholesterol. “The more recent statins, atorvastatin and rosuvastatin, tend to be more efficacious than early statins,” Tracy says.
2. Who should take statins?
When it comes to who should take statins, patients can fit into two groups.
“The first group of patients that we absolutely start on statins is for secondary prevention,” Tracy says. “So those who’ve already had a stroke or a heart attack, we use statins in those instances.”
The goal for these patients is to prevent another dangerous cardiac event.
The second group includes people who may be at risk for heart and vascular problems but have not had a major issue yet. They take statins to reduce their risks. This is called primary prevention.
Patients looking for primary prevention have a few things to consider with their physicians before going on statins. They include the patients’ family history of heart disease or high cholesterol, their own cholesterol levels and other factors that may put them at higher risk for heart and vascular problems.
“Patients who have familial high cholesterol or those who have an LDL cholesterol greater than 160 and have not had a heart attack would be examples of patients that fit into the primary prevention group,” Tracy says.
Another way to measure risk is with a coronary calcium score. You get this score when you take a coronary calcium scan. It’s a simple imaging test that measures calcium, which is cholesterol that has already built up and calcified, in your coronaries.
“We look to see if their coronary calcium score is zero. That's what we want,” Tracy says. “Any score above zero indicates increasing risk for a heart attack.”
It’s very important to control LDL cholesterol if you have calcium in your arteries, and statins may help with that.
You can find out your coronary calcium score and take other heart tests at RUSH starting at just $49. Visit our Heart and Vascular Screenings page to learn more.
3. What age should I start on statins?
Even though most patients start on statins in their 40s or 50s, the age you should start taking statins really depends on you and your individual risks.
“I would say in our 40s and 50s, we start to respect our mortality and we want to get on the bandwagon of being healthier,” Tracy says. “And most studies on statins are also in that age group.”
But your physician may recommend that you start earlier if you’re at higher risk for heart and vascular problems at a younger age.
“I actually have patients in their 20s who have family members who have had strokes,” Tracy says. “One young lady is a junior in college, and her mother has elevated cholesterol. But her mother's brother has elevated cholesterol and had a stroke in his 40s. And this young lady has an abnormal lipid panel despite her very healthy lifestyle. So now she takes a statin. Her mother and uncle were also in agreement to this decision the patient and I made.”
Social media has also raised awareness about heart disease, calcium coronary scans and statins among different age groups. This has helped people of many ages learn about available tests to measure their cardiovascular risk and see if they should take statins.
If you are concerned about your heart health, your cholesterol or your family history, you should talk to your physician about statins, regardless of your age.
4. What testing do I need before I take them?
Before you go on statins, your physician will likely want to run some tests. The first they will use is a blood test that includes a lipid panel. Your physician may need you to fast before you have your blood drawn.
This lipid panel gives a measure of a few different things related to your heart health, which include the following:
- LDL cholesterol: This is the “bad” cholesterol that can build up in blood vessels, causing plaque and leading to heart problems. A high number here is a sign of higher risk.
- Very low-density lipoprotein cholesterol: A high amount of this type of cholesterol, often shortened to VLDL cholesterol, could mean your metabolism is not normal.
- High-density cholesterol: Also called HDL cholesterol, this is the “good” cholesterol that can help prevent LDL cholesterol from forming plaque in your blood vessels. HDL tends to be protective, and low HDL can mean higher risk. But a very high HDL of the wrong particle size can also contribute to plaque buildup. Checking the particle size can be very helpful.
- Triglycerides: This is fat that comes from the food you eat. A high number could mean greater risk.
Your blood test should also include a measurement of creatine kinase, usually shortened to CK, in your blood.
CK is a muscle enzyme, and statins may cause it to spike, which can lead to muscles breaking down quickly. It’s important to get a baseline measure of your CK to monitor you while you’re on statins and see if there’s a spike.
Your blood test should include liver function tests. These can check for liver disease or abnormal liver function. One possible side effect of statins is liver irritation, so they may not be a good choice for patients who already have liver problems.
In some cases, your physician may advise that you get a coronary calcium scan, too. It’s a simple CT scan that doesn’t require you to get an IV or inject any dyes.
Your coronary calcium score does not measure your cholesterol, but it can show whether calcium has already started to build up in your arteries. If it has, it’s even more important to start primary prevention, which can include statins.
You will likely need to repeat some of these tests about four weeks after starting statins to monitor for any changes. After that, you may need to take the tests again when there are changes in dosage, as well as annually.
5. Do I still need to diet and exercise with statins?
In short, yes, you will still need to be careful with your diet and stick to an exercise regimen.
When it comes to preventing heart and vascular problems, statins can help, but they do not fully replace healthy lifestyle changes.
“I urge patients to implement diet, exercise and weight loss,” Tracy says. “We know that by aggressive diet, exercise and weight loss, we can lower LDL cholesterol by about 20%.”
But Tracy also notes that lowering LDL cholesterol by that much requires a very strict diet and a more intense exercise regimen. Diet and exercise alone may also not be enough for prevention, which is where statins can provide support.
“So I still couple starting a statin with diet and exercise and weight loss. Absolutely,” Tracy says. “To me, that has to be a happy marriage of two partners.”
6. Who should not take statins?
Statins can be very helpful for many patients who want to prevent cardiovascular problems, but they aren’t always safe for everyone.
Patients who are pregnant or want to become pregnant should not take statins. If you are trying to become pregnant and are on a statin, you should talk to your physician about getting off the medication first.
Those who are elderly may also choose not to go on statins. There are certain risks of side effects, so if you’re of an advanced age, you and your physician may need to weigh the risks and benefits.
If you have poor liver function or liver disease, you should also talk to your physician. Statins can cause liver irritation and possibly worsen your condition.
Finally, if you have certain myopathies, or diseases that break down the muscles, statins may not be a good solution for you.
For example, McArdle disease is a genetic disorder that affects skeletal muscle. You may not realize you have this condition, which is one reason why testing is so important.
7. Are there any health risks or side effects?
There are a few side effects that may appear with statins, but the risk of serious problems is very low.
Side effects of statins are called “statin induced symptoms.” The most common are muscle aches, joint aches and fatigue.
Other less common side effects include liver irritation or statin-induced myopathies, which are very rare conditions that break down muscles.
You may have heard that statins can cause dementia. But this connection has, so far, only been anecdotal. That means that some people claim statins have caused dementia, but several studies haven’t yet shown an association between statins and dementia.
But some studies have shown a link between statins and diabetes.
“The connection of statins with diabetes is a bit stronger," Tracy says. “But for those patients that we have on statins, we have to do the risk versus benefit for the very low chance of developing diabetes and the high positive benefit on their coronary or cerebral circulation.”
Interestingly, statins also have a strong “nocebo” effect. This is when a medication can make a patient feel side effects just because they expect to.
In fact, studies have been done with patients who thought they were taking statins and instead took placebos. They reported the same amount of muscle and joint pain or more than when they took real statins.
Regardless of which side effects you may feel, you should talk to your physician. They can adjust your dosage, try a different statin or look into alternatives to statins that may help.
8. What are the alternatives to statins?
For those who can’t take statins or choose not to, there are other options that can help lower cholesterol. Some of these options include the following:
- Ezetimibe: This medication can lower LDL cholesterol, but it doesn’t affect the liver. It can be a good alternative for patients with liver problems. It does have a few drawbacks, though. First, it doesn’t have the anti-inflammatory effects of statins. It also hasn’t been shown to reduce mortality from heart conditions as much as statins do. It only lowers LDL cholesterol and lacks many of the other benefits that come with statins.
- Bempedoic acid: This is another new medication that can lower cholesterol. It’s the new "non-statin statin.” It’s often recommended to be used with a statin, but it can also act as an alternative for patients who can’t be on them, especially those with muscle diseases.
- PCSK9 inhibitors: These are medications that you’ll inject yourself with twice a month. They can lead to dramatic lowering of LDL cholesterol and reduce the risk of serious disease and death from heart and vascular problems.
With any of these alternatives, you’ll still need monitoring with your physician, just as you would with statins. You’ll likely also need to combine them with diet and exercise.
Any time is a good time to check your heart and vascular health with your physician. But during February, we celebrate Heart Month to raise awareness and encourage you to get tested.
“February being Heart Month always helps,” Tracy says. “We see a lot of patients during February who want to go to their primary care physician or cardiologist and just see what's going on with them.”
Testing can help you start prevention with statins or alternatives before you have major heart or vascular issues.
If you need statins or other treatment for heart or vascular conditions, call RUSH at (888) 352-7874 to get an appointment. You can also visit our Heart and Vascular Care page to learn more.
