Preventive Cardiology: Statins

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Common Names

  • Lovastatin (Altoprev, Mevacor)
  • Simvastatin (Zocor)
  • Pravastatin (Pravachol)
  • Fluvastatin (Lescol)
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)

Current Uses

Treatment

Statins may be prescribed if you have:

Prevention

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.

Side Effects

Drug Interactions

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)

Other Interactions

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:

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

Less Common Side Effects

Less common, but more serious side effects include:

  • Liver problems
  • Myopathy (muscle weakness)
  • Rhabdomyolysis
  • Kidney failure
  • Memory problems and confusion
  • Increased blood sugar levels

Recommendations

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

Revisions

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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