Statins: What You Need to Know

Cholesterol is a waxy, fat-like substance that travels through the blood. Too much can increase your risk for heart attack or stroke.

Our bodies make and need some cholesterol for normal cell and body function. But too much can be harmful. Very high levels can promote plaque buildup in the walls of arteries  and block blood flow as a result.

Unlike a headache, chest cold or stomach upset, high cholesterol usually has no symptoms. But it’s a big red flag when it comes to the likelihood that someone will develop heart or blood vessel problems.

Statins lower cholesterol in the blood by reducing the liver’s ability to make cholesterol. This, in turn, allows the liver to accept more cholesterol from the blood, thereby driving down cholesterol levels. They can drive down low-density lipoprotein (LDL) cholesterol levels — the “bad” cholesterol — by more than 50%.

Statins also appear to help prevent heart attacks and strokes by keeping plaques from rupturing (breaking apart) and forming clots that can move to the heart or brain. In addition, they can lower triglycerides and slightly boost high-density lipoprotein (HDL) cholesterol – known as the “good” cholesterol.

Statins work best when combined with a heart-healthy eating plan, regular exercise and other healthy lifestyle choices.

Facts about Statins

• Statins:
  
  • Are among the most well-studied and widely prescribed medications.
  • Work by blocking an enzyme that is used by the liver to make cholesterol.
  
  
• 1987: The year the first statin was approved. There are now at least 7 different statins available.


• Nearly half  of Americans: Those who could stand to benefit from taking a medication to help lower their cholesterol and the chance of having a heart attack or stroke but are not.

Statins are often recommended to help prevent a first heart attack or stroke (called primary prevention).

They are also used to reduce the risk of having a repeat heart attack or stroke  in someone who has already had one (called secondary prevention).

In general, you should consider being on a statin if you: *

• Have existing heart disease or a history of stroke, heart attack, peripheral vascular disease or chest pain (angina) (this is to prevent further problems – called secondary prevention)
• Have high cholesterol (LDL of 190 mg/dL or higher)
• Are between 40 and 75 years of age and also have diabetes
• Are between 40 and 75 years of age and your clinician estimates how likely you are to have a heart attack or stroke or die from one in the next 10 years (called your 10-year risk score), and your risk is high enough to benefit from being on one

_{* Note: Based on guidelines set forth by the American College of Cardiology and the American Heart Association}

If you or a loved one is over 75 years of age and have never been on a statin, the benefit of starting one is unclear so you should talk with your health care provider and decide what’s best.

Remember: If your health care provider suggests that you take a statin, it’s all to help lower the chances that you will have a heart attack or stroke caused by atherosclerotic cardiovascular disease (ASCVD).

ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can build up and narrow the arteries.

Your health care provider may have already talked with you about how a risk calculator can be used to determine your risk of developing ASCVD or having a heart attack or stroke. This calculator factors in things like:

• Your age
• Gender
• Race
• Cholesterol
• Systolic blood pressure (the top number)
• If you smoke
• If you have diabetes

Because your risk can change over time, it’s important to have ongoing conversations with your health care provider about what steps you can take to stay healthy.

Keep in mind that making lifestyle changes–in addition to taking a statin or other medication–can help protect your heart and improve your overall health.

• Know why your health care provider recommended a statin to begin with. If you have questions, ask.
• Share any concerns. Be open about any concerns that might get in the way of you actually filling the prescription or taking it the right way. For example, concerns about:
• taking a daily medication (you might be especially hesitant if this is your first)
• adding yet another to the others you already take
• possible side effects you’ve heard or read about
• costs
• Report any side effects. Side effects are uncommon, but if you do have any, your health care provider can try a new statin or adjust the dose (amount) you are taking. There are a lot of choices available to you and your health care providers. In some cases, your doctor may want to run other tests to determine if certain symptoms have other causes. For example, checking your vitamin D or thyroid levels.
• Keep any follow up appointments. Most often, your health care provider will start you on a high intensity statin. At certain points in time, and especially a few weeks after starting one, he or she will want to recheck your blood work, including your cholesterol levels to assess how the statin is working.
• Never stop taking your statin (or any prescription medicine) without talking with your health care provider first.
• Ask if you should avoid certain medications or foods. Certain beverages, foods and medications may change the way your statin – or other medications – work. For example, grapefruit juice can make some statins more potent, and should be avoided as it also interacts with many other medications.
• Talk with your health care provider if you are or plan to become pregnant.
• Update your medical history. Anytime you start a new therapy like a statin, it’s a good idea to tell your other health care providers.

Assess and determine your risk.

• Get your blood cholesterol levels checked
• Review with your health care provider the other factors that raise your risk for heart attack and stroke

Begin treatment if you’re deemed to be at high risk for heart attack or stroke.

• You may not “feel” better taking a statin; that’s because it is to prevent problems
• Don’t stop taking a statin without talking with your health care provider

Come back for repeat testing.

• After you’ve been on a statin for a few weeks (usually 6-8), blood tests can help gauge how well it is working
• Treatment can be adjusted, as needed

Not all statins are the same. If you have a side effect with one or even several of the available statins, you still may be OK to take a lower amount (dose) of statin, a different statin or a (non-daily) longer-acting statin.

If statins aren’t enough to lower your ASCVD risk or, in the unlikely event you can’t take them for some reason, your health care provider may recommend non-statin therapies.

These might include ezetimibe, which blocks cholesterol from being absorbed in the intestine, and the newer proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.