Millions worldwide take statin medications, but who needs them? What varieties exist? How do they function? And what are the potential side effects?
What Are Statins?
Statins are pills taken to lower cholesterol levels. Cholesterol is a fundamental component of cell membranes. However, when present in excess, it can accumulate inside the walls of arteries as cholesterol plaque.
Cholesterol-laden plaque contributes to heart disease in various ways, according to a report from Harvard University.
Cholesterol buildup can narrow arteries and even lead to blockages. If a cholesterol plaque ruptures, a blood clot forms, potentially triggering a heart attack or stroke.
Moreover, cholesterol can cause artery inflammation, which may further contribute to clot formation.
Sometimes, you can lower cholesterol levels with dietary changes and increased activity. However, if levels remain high, statin medication or other drugs may be necessary.
How Do Statins Work?
Statins affect the liver’s cholesterol production mechanism, particularly the production of low-density lipoprotein (LDL), also known as “bad” cholesterol.
Statins lower bad cholesterol levels, slowing the accumulation in arteries.
Furthermore, statins reduce inflammation in artery walls. If you have plaque buildup in the arteries, statins can help prevent it from rupturing and causing blood clots.
Once you start taking a statin (or any cholesterol-lowering drug), it’s likely a lifelong commitment. If you stop, the protective effects of the statin disappear.
Who Needs Statins?
Individuals with high levels of bad cholesterol, those who have suffered heart attacks or strokes, or those at risk for diabetes (a heart disease risk factor) and over the age of 40 typically need statins.
Why Take Cholesterol Medication Before Bed?
For most statins, manufacturers do not recommend a specific time of day for your dose. However, studies have found some statins work better when taken in the evening, likely because the liver produces most cholesterol when we eat less—usually at night.
Can Pregnant Women Take Statins?
Pregnant women should not take statins. Current medical guidelines advise working with a doctor to stop taking statins at least three months before conception. Doctors will likely recommend stopping statin use throughout pregnancy (about 40 weeks) and as long as a woman chooses to breastfeed.
For most women, this equates to stopping statins for at least one year.
It’s essential to work with a doctor to ensure cholesterol levels don’t dangerously rise.
Liver Disease
People 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’s the Best Cholesterol Medication?
There’s no “best” type; it depends on your condition. Your doctor will choose the most suitable statin by considering the amount you need to lower your LDL cholesterol and other medications you take.
Sometimes, people may experience side effects from one statin, but they can tolerate another.
Potential Side Effects of Statins
More than three decades of research have proven statins to be safe and effective. However, like all medications, statins can cause side effects.
The most common statin side effects are:
- Muscle pain.
- Feeling tired.
Less common statin side effects are:
- Headaches.
- Constipation.
- Diarrhea.
- Sleep problems.
Statins and Muscle Pain
A study published in 2022 in The Lancet analyzed over 150,000 individuals in randomized trials for statins, examining those who complained of muscle pain after taking statins or a placebo.
The study found that over 90% of these symptoms were not linked to statin use. The researchers concluded that the risk of muscle problems is low compared to statins’ health benefits.
Dealing with Statins’ Side Effects
Muscle pain is the primary reason people desire 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 once your body adjusts to the statin. If not, your doctor may suggest a different statin drug or a lower dose. Sometimes, taking a low dose every other day, for example, may be recommended.
Statin Alternatives
Some individuals cannot tolerate statins’ side effects or continue to have high cholesterol levels despite using statins.
Other medications and methods can help lower cholesterol levels.
Non-Statin Drugs
Several drug classes help lower cholesterol levels. These include:
Ezetimibe (Zetia)
Ezetimibe reduces the amount of cholesterol your body absorbs from food (or reabsorbed from what the liver has excreted).
Bempedoic Acid (Nexletol)
Bempedoic acid blocks cholesterol production in the liver. The drug doesn’t reach muscle cells, making it a potentially effective option for those who experienced muscle pain with statins.
It can be taken alone but is usually combined with other cholesterol-lowering medications. Side effects include gout (especially for those with a history of gout), a slight increase in creatinine (a measure of kidney function), and gallbladder inflammation.
Bile Acid Sequestrants
Bile acid sequestrants prevent bile acid in the digestive tract from being absorbed into your bloodstream. This makes the liver take cholesterol from your blood to produce the bile acid it needs. Side effects include constipation, heartburn, nausea, diarrhea, and muscle pain.
PCSK9 Inhibitors
PCSK9 inhibitors are a newer type of cholesterol medication meant for people with a genetic condition causing very high LDL cholesterol levels, or for those with heart disease who didn’t achieve a significant cholesterol reduction with maximum statin doses.
They help the liver remove cholesterol from the blood and are given via injection, costing more than statin pills. Side effects include flu-like symptoms and injection site pain.
Non-Medication Ways to Lower Cholesterol
Some people can lower their cholesterol without medication by making lifestyle changes, such as:
- Following a healthy diet—The DASH eating plan from the National Heart, Lung, and Blood Institute is one example, focusing on fruits, vegetables, whole grains, fish, poultry, beans, nuts, and low-fat dairy. It limits sugary beverages, sweets, and foods high in saturated fats, such as fatty meats and full-fat dairy products.
- Weight loss—If you’re overweight, losing weight can decrease LDL cholesterol.
- Regular physical activity—Aiming for 30 minutes each day.
- Stress management.
- Quitting smoking.
