The Important Facts on Cholesterol Lowering Drugs

Our bodies need cholesterol to form cell membranes, to help break down some dietary fats, and for some hormones.  Our liver is capable of making all the cholesterol we need, but we also consume cholesterol when we eat animal products (egg yolks, whole milk, and red meat) and saturated fats.  Our bodies can use this dietary cholesterol, but our livers will still produce cholesterol on their own.

Too much cholesterol can cause heart disease and stroke because the excess clogs arteries.  For people who cannot lowering cholesterol through diet and exercise alone, statins may be prescribed.  Statins work by turning off the mechanism in the liver that produces cholesterol, so the only source of cholesterol is from the diet.  In this way, statins lower total and LDL (“bad”) cholesterol.  Statins have been proven to lower the incidence of cardiovascular events in people with heart disease.  Statins lower the progression of atherosclerosis, and in some cases may result in regression of the disease.

Additionally, a study published in the Journal of the American Medical Association found that statins also increase HDL (“good”) cholesterol, thereby stopping cardiovascular disease progression.  The report says that statins stop plaque progression because of their ant-inflammatory properties, which reduce LDL cholesterol and increase HDL levels.

Statins include atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others.

Are Statins right for you?

According to the Mayo Clinic, statins do lower cholesterol, but “doctors are far from knowing everything about statins.”  Having high cholesterol (240 mg/dL or higher), or high LDL cholesterol (130 mg/dL or higher) does not necessarily mean your doctor will prescribe a statin.  “If the only risk you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low.  High cholesterol is only one of a number of risk factors for heart attack and stroke.”

Other risk factors for cardiovascular disease include a family history of the disease, inactive lifestyle, high blood pressure, age of 55 or above for men and 65 or above for women, diabetes, obesity, and smoking.

Once on a statin, you will probably have to be on it for the rest of your life, unless you lose a lot of weight or adopt a better diet.  Otherwise, if you stop taking the medication your cholesterol levels will probably go back up.

A study published in the Journal of the American Medical Association says that people with a genetic variant in the HMG-CoA reductase gene “may experience significantly smaller reductions in cholesterol when treated with pravastatin.”  As with all medications, a person’s genes will influence the mechanisms of statins.

For people who are weary of taking pills to manage cholesterol, red yeast rice of red rice extract capsules may be an option.  They contain a “natural” statin, and will lower LDL cholesterol 5-15%.  However this red rice has a high carbohydrate load, which must be taken into consideration.  It must be stressed that you talk with your doctor before beginning this regime, as statins are extremely effective for people at risk for CAD.

Side Effects

Most people tolerate statins well.  Some less serious side effects—muscle and joint aches, nausea, diarrhea, and constipation—usually go away as the body gets used to the medication.

Potentially hazardous side effects include liver and muscle damage.  Sometimes statins may increase instead of decrease the liver enzyme.  “If left unchecked, increased liver enzymes may lead to permanent liver damage” (Mayo Clinic).  Liver problems are particularly dangerous because they often develop without symptoms.  For this reason, people on statins must have a blood test six weeks after starting the medication.

As for muscle damage, “The higher dose of statin you take, the more likely you are to have muscle pains” (Mayo Clinic).  In severe cases, statins may cause muscle cells to break down, releasing myoglobin into the blood.  Myoglobin is damaging to the kidneys.  When combined with statins, certain drugs increase this risk, and include gemfibrozil, erythromycin, antifungal medications, nefazodone, cyclosporine and niacin.

People who are most at risk for statin side effects include females, people taking multiple medications to lower cholesterol, having a small body frame, being 65 and older, having kidney or liver disease, and having diabetes.

According to the Cleveland Clinic, “statins have been shown to be extremely safe medications.  They can have side effects but these are easily identified and managed.  The only serious adverse side effect reported for statins is rhabdomyalisis, a severe inflammation in the muscle.  This occurs at a frequency of about 1 in 20,000.”

Potential Benefits

Since statins have anti-inflammatory properties, statins may decrease risk of heart attack, stroke, arthritis, and kidney disease.

Questionable Benefits?

A study published in London on June 28, 2010 said “There is no evidence that prescribing cholesterol-lowering drugs known as statins to patients at risk of heart disease reduces their changes of premature death in the short term.”  The study examined patients who do not have heart disease but are at risk for it.  The study, published in the Archives of Internal Medicine journal, says “There is little evidence that statins reduce the risk of dying from any cause in individuals without heart disease.”

However, most data on the beneficial effects of statins is done on patients who have cardiovascular disease, for whom statins is effective at slowing disease progression.  Furthermore, the study only examined the patients 3.7 years on average after the medication and placebo were given.

Professor Peter Weissberg of the British Heart Foundation said “The people in these studies were followed for less than four years on average.  Since heart and circulatory disease develop over many decades, it’s reasonable to assume that we would see a significant improvement in morality over a longer period of follow-up.”  Additionally, the study only examined the incidence of premature death.  Weissberg also said, “Many studies have shown that statins prevent non-fatal heart attacks and strokes.  Preventing serious ill health, such as heart failure resulting from a heart attack, or disability due to a stroke, is every bit as important as lengthening lives.”