Preventive Cardiology: Statins
- Lovastatin (Altoprev, Mevacor)
- Simvastatin (Zocor)
- Pravastatin (Pravachol)
- Fluvastatin (Lescol)
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
Statins may be prescribed if you have:
- High total cholesterol
- High LDL ("bad") cholesterol
- Low HDL ("good") cholesterol
- High triglyceride levels
- Coronary artery disease
If you already have cardiovascular disease, your doctor may recommend statins to reduce your risk of having a heart attack or stroke. Some people may benefit from a statin even if they have no history of cardiovascular disease but are at high risk.
Mechanism for How It Works
HMG-CoA reductase is an enzyme that helps your body make cholesterol. Statins help to block this enzyme, which in turn causes your body to make less cholesterol. When you make less cholesterol, your liver makes more LDL receptors, which attract LDL particles in the blood. This reduces the amount of LDL ("bad") cholesterol in your bloodstream. Lower LDL cholesterol levels also tend to lead to lower levels of triglycerides and higher HDL (“good”) cholesterol levels in the blood. Statins have anti-inflammatory effects on blood vessels which help reduce the formation of fatty plaque on blood vessel walls.
Statins can interact with many medicines. Below are some examples. But, you should talk to your doctor and pharmacist about the specific medicines that you are taking.
- Cyclosporine (eg, Gengraf)
- Erythromycin (eg, Erythrocin)
- Gemfibrozil (eg, Lopid)
- Nefazodone (eg, Serzone)
- Verapamil (eg, Calan)
- Digoxin (eg, Lanoxin)
- Protease inhibitors to treat HIV, such as indinavir (eg, Crixivan), nelfinavir (eg, Viracept), ritonavir (eg, Norvir), saquinavir (eg, Invirase)
Statins can interact with certain foods, herbs, and supplements. Here are examples of potential interactions:
- Grapefruit juice —increases the absorption of most statins, allowing potentially excessive levels to build up in the bloodstream
- Chaparral, comfrey, and coltsfoot—may increase the risk of liver problems
- St. John’s wort—may decrease blood levels of some statins
- Vitamin B3— possibly increases the risk of developing a potentially fatal condition called rhabdomyolysis
- Red yeast rice—contains a mixture of statins and should not be combined with statin drugs
If you would like to take herbs or supplements while taking a statin, check with your doctor first.
Other Potential Concerns
These conditions can affect how your body uses statins:
- Allergy or intolerance to statins or allergies to other substances, including food
- Obesity—can make statins less effective
- Positive changes in diet and exercise—may need a lower dose
If you have any of the following conditions, tell your doctor before you are prescribed statins:
- Alcohol abuse
- Liver disease
- Organ transplant and take medicine to prevent transplant rejection
- Recent major surgery
- Pregnant or breastfeeding—Statins are not recommended in pregnant or nursing women.
Common Side Effects
More common side effects include:
- Upset stomach
- Abdominal pain
- Flu-like symptoms
- Muscle pain
- Skin rash
Less Common Side Effects
Less common, but more serious side effects include:
- Liver problems
- Myopathy (muscle weakness)
- Kidney failure
- Memory problems and confusion
- Increased blood sugar levels
American Heart Association
US Food and Drug Administration
Heart and Stroke Foundation of Canada
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1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol. 2008;52:1769-1781.
3/6/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnounce...ts/ucm293623.htm. Published February 28, 2012. Accessed March 6, 2012.
Last reviewedDecember 2012by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.