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Preventive Cardiology: Statins

Commonly Prescribed Statins    TOP

  • Lovastatin
  • Simvastatin
  • Pravastatin
  • Fluvastatin
  • Atorvastatin
  • Rosuvastatin

Current Uses    TOP

Treatment

Statins are primarily prescribed for:

Prevention

If you already have cardiovascular disease, your doctor may recommend statins to reduce your risk of having a heart attack or stroke. Statin therapy may also be prescribed if you fall within a specific risk range for developing cardiovascular disease within 10-years. The risk can be assessed based on your cholesterol numbers and other risk factors. It can be done during a regular physical exam.

Mechanism for How It Works    TOP

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.

Side Effects    TOP

Drug Interactions

Statins can interact with many medications. Below are some examples. But, you should talk to your doctor and pharmacist about the specific medications that you are taking.

  • Cyclosporine
  • Erythromycin
  • Gemfibrozil
  • Nefazodone
  • Verapamil
  • Digoxin
  • Protease inhibitors to treat HIV, such as indinavir, nelfinavir, ritonavir, saquinavir

Other Interactions

Statins can interact with certain foods, herbs, and supplements. Here are examples of potential interactions:

  • Grapefruit juice —may increase 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    TOP

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 use disorder
  • Liver disease
  • Organ transplant and take medication to prevent transplant rejection
  • Recent major surgery
  • Pregnant or breastfeeding—Statins are not recommended in pregnant or nursing women.

Common Side Effects    TOP

More common side effects include:

  • Gas
  • Upset stomach
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Headache
  • Flu-like symptoms
  • Fatigue
  • Muscle pain
  • Skin rash

Less Common Side Effects    TOP

Less common, but more serious side effects include:

Recommendations    TOP

  • Take only the amount of statin ordered by your doctor
  • Do not stop taking this medication without first checking with your doctor
  • Tell your doctor or dentist about taking this medication before having any kind of surgery, dental procedure, or emergency treatment

RESOURCES:

American Heart Association
http://www.heart.org
US Food and Drug Administration
http://www.fda.gov

CANADIAN RESOURCES:

Heart & Stroke Foundation
http://www.heartandstroke.com

REFERENCES:

Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-559.
Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110(2):227-239.
Lemaitre RN, Psaty B, Heckbert SR, Kronmal RA, Newman AB, Burke GL. Therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults. Arch Intern Med. 2002;16(12)2:1395-1400.
Statins. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116844/Statins. Updated September 1, 2015. Accessed October 24, 2016.
Statins. Food and Drug Administration website. Available at:
...(Click grey area to select URL)
Updated December 16, 2014. Accessed October 24, 2016.
Statin drugs. EBSCO Natural and Alternative Treatments website. Available at:
...(Click grey area to select URL)
Updated December 15, 2015. Accessed October 24, 2016.
Statins for prevention of cardiovascular disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 8, 2016. Accessed October 24, 2016.
Stender S, Schuster H, Barter P, Watkins C, Kallend D, MERCURY I Study Group. Comparison of rosuvastatin with atorvastatin, simvastatin, and pravastatin in achieving cholesterol goals and improving plasma lipids in hypercholesterolaemic patients with or without the metabolic syndrome in the MERCURY I trial. Diabetes Obes Metab. 2005;7(4):430-438.
Tahara N, Kai H, Ishibashi M, et al. Simvastatin attenuates plaque inflammation: evaluation by fuorodeoxyglucose positron emission tomography. J Am Coll Cardiol. 2006;48(9):1825-1831.
1/30/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed...: 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(22):1769-1781.
Last reviewed October 2016 by Michael Woods, MD
Last Updated: 10/24/2016

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