Millions around the world take statin medications, but who needs them? What types are there? How do they work? And what are their side effects?
What are Statins?
Statins are medications taken in pill form to lower cholesterol levels. Cholesterol is a fundamental component of cell membranes. However, when there is too much of it, it can build up inside the artery walls. This is known as cholesterol plaque.
Cholesterol-laden plaque contributes to heart disease in various ways, according to a report from Harvard University.
Excessive accumulation of cholesterol can narrow arteries and even lead to blockages. If a cholesterol plaque ruptures, a blood clot forms at that spot, potentially leading to a heart attack or stroke.
Cholesterol can also cause inflammation in the arteries, which may contribute to clot formation that blocks them.
Sometimes, you can lower cholesterol levels simply by changing your diet and increasing your activity. But if levels remain high, you may need a statin or another medication to lower it.
How Do Statins Work?
Statin drugs affect the liver's mechanism for producing cholesterol. More importantly, they inhibit the production of low-density lipoprotein (LDL), known as bad cholesterol.
Statins lower levels of bad cholesterol, thus slowing the accumulation of cholesterol in the arteries.
Statins also act to reduce inflammation in the artery walls. If you have cholesterol plaque buildup in your arteries, statins can help prevent them from rupturing and causing blood clots.
Once you start taking a statin (or any cholesterol-lowering medication), it's likely you'll be on it for life. If you stop, the protective effects of the statin will cease.
Who Needs Statins?
People with high levels of bad cholesterol, those who have had a heart attack or stroke, anyone at risk for diabetes (a risk factor for heart disease), and those over the age of 40.
Why Take Cholesterol Medicine Before Bed?
For most statin medications, manufacturers do not recommend a specific time of day for your dose. However, studies have found that taking some statins at night can be more effective. This is because the liver produces most cholesterol when we eat less — typically at night.
Can Pregnant Women Take Statins?
Pregnant women should not take statins. Current medical guidelines recommend working with a doctor to stop taking statins for at least 3 months before pregnancy. It is likely the doctor will advise stopping statins for the entire pregnancy (about 40 weeks) and as long as the woman chooses to breastfeed.
For most women, this equates to at least a year of stopping statin use.
Working with a doctor is important to ensure cholesterol levels don't become dangerously high.
Liver Disease
Individuals with liver disease should not take statins.
Types of Statins
- Atorvastatin (Lipitor).
- Fluvastatin (Lescol).
- Lovastatin (Mevacor).
- Lovastatin extended release (Altoprev).
- Pitavastatin (Livalo).
- Pravastatin (Pravachol).
- Rosuvastatin (Crestor).
- Simvastatin (Zocor).
What is the Best Cholesterol Medicine?
There is no single best type; it depends on the individual's situation. Your doctor will choose the statin that may suit you best by considering factors like how much you need to lower your bad cholesterol and other medications you are taking.
Sometimes, people may experience side effects from one statin medication but can tolerate another.
Possible Side Effects of Statins
Research spanning more than three decades has shown that statins are safe and effective. Like all medications, statins can have side effects.
The most common side effects of statins are:
- Muscle pain.
- Feeling tired.
Less common side effects of statins include:
- Headaches.
- Constipation.
- Diarrhea.
- Sleep problems.
Statins and Muscle Pain
A 2022 study published in the medical journal The Lancet reviewed the records of over 150,000 people in randomized trials of statins and analyzed those who suffered muscle pain after taking statins or a placebo.
The study found that over 90% of those symptoms were not associated with the use of statins. Researchers concluded that muscle problems are low risk compared to the health benefits of statins.
Managing Statin Side Effects
Muscle pain is the main reason why people want to stop using statins. Studies have evaluated various treatments for statin muscle pains, including vitamin D and Coenzyme Q10, but found no evidence that any are effective.
In many cases, side effects will disappear as your body adjusts to the statin. If not, your doctor may suggest switching to a different statin medication or taking a lower dose, and sometimes taking the low dose every other day, for example.
Statin Alternatives
Some people cannot tolerate the side effects of statins, and others still have high cholesterol levels even after taking statins for some time.
There are different medications you can try and other ways to lower cholesterol levels.
Non-Statin Medications
There are many classes of medications that help lower cholesterol levels. These drugs include:
Ezetimibe (Zetia)
Ezetimibe reduces the amount of cholesterol your body absorbs from food (or reabsorbs from what the liver excretes).
Bempedoic Acid (Nexletol)
Bempedoic acid blocks cholesterol production in the liver, but the drug does not reach muscle cells, so it can be an effective option for people who experienced muscle pains with statins.
It can be taken on its own, but typically it is taken with other cholesterol-lowering medications. Side effects include gout (especially among those with a history of gout), a slight deterioration in creatinine (a measure of kidney function), and gallbladder inflammation.
Bile Acid Sequestrants
Bile acid sequestrants prevent bile acids in the digestive tract from being absorbed back into the blood. This causes the liver to take cholesterol from the blood to make the bile acid it needs. Side effects include constipation, heartburn, nausea, diarrhea, and muscle aches.
PCSK9 Inhibitors
PCSK9 inhibitors are a newer type of cholesterol medication. These drugs are intended for people with a genetic condition that causes very high bad cholesterol levels and also for people with heart disease who have not lowered their cholesterol levels sufficiently with the maximum dose of statins.
PCSK9 inhibitors work by helping the liver remove cholesterol from the blood.
These inhibitors are given by injection and are more costly than statin pills. Side effects include flu-like symptoms and injection site pain.
Non-Drug Ways to Lower Cholesterol
Some people may lower their cholesterol levels without medication by making lifestyle changes. These changes include:
- Adopting a healthy diet, such as the DASH diet provided by the American National Institute of Heart, Lung, and Blood, which focuses on fruits, vegetables, whole grains, fish, poultry, beans, nuts, and low-fat dairy. It limits sugary drinks, sweets, and foods high in saturated fat, such as fatty meats and full-fat dairy products.
- If you are overweight, losing weight can reduce bad cholesterol levels.
- Regular physical activity, aiming for 30 minutes each day.
- Managing stress.
- Quitting smoking.
