Statins for high cholesterol

Examples

Generic Name	Brand Name
atorvastatin	Caduet [also contains amlodipine, a calcium channel blocker], Lipitor
ezetimibe and simvastatin	Vytorin
fluvastatin	Lescol, Lescol XL
lovastatin	Altoprev, Mevacor
lovastatin, extended-release	Altocor
niacin and lovastatin, extended-release	Advicor
pravastatin	Pravachol
rosuvastatin	Crestor
simvastatin	Zocor

How It Works

Statins block an enzyme the body needs to produce cholesterol. As a result, LDL ("bad") cholesterol levels in the blood go down, thereby lowering total blood cholesterol levels.

The combination medicine Vytorin lowers cholesterol in two ways: with a statin, which blocks the production of cholesterol in the liver, and with ezetimibe, which reduces the amount of cholesterol absorbed by the intestines.

Why It Is Used

Statins are used to lower the risk of heart attack, stroke, and death in people with known heart disease and in people at high risk for coronary artery disease (CAD).¹ Statins may be used alone or, for people with very high cholesterol, can be combined with bile acid sequestrants, niacin, or ezetimibe (Zetia).

How Well It Works

Studies show that statins reduced the risk of heart attack and death in people who have taken these medicines to lower their cholesterol.

• Studies show that intensive cholesterol-lowering therapy decreases the progression of coronary artery disease (CAD), compared with standard treatment.^{2, 3} In the PROVE IT study, people who recently had episodes of unstable angina or heart attacks received higher-than-standard doses of cholesterol-lowering drugs and had fewer subsequent heart attacks and strokes, and there were fewer deaths. This large study suggests that intensive statin therapy could save lives. The U.S. National Cholesterol Education Panel guidelines include more intensive treatment with statins as an option for people who are at moderate to high risk of heart attack.⁴
• A review of large clinical studies showed that statins may lower the risk of stroke in people who have CAD.¹
• LDL can be reduced by 18% to 55%.⁵ The newer, more potent statins can reduce LDL levels even further. These statins include atorvastatin (Caduet, Lipitor) and simvastatin (Zocor).
• HDL can be increased by 5% to 15%.⁵
• Triglycerides can be reduced by 7% to 30%.⁵ The newer, more potent statins may lower triglyceride levels even more.
• Two studies show that intensive statin treatment also lowers levels of C-reactive protein (CRP), a biochemical marker associated with an increased risk of CAD and heart attack. Lowering CRP along with LDL significantly reduces heart attack and death in those who have had a previous heart attack or unstable angina.^{6, 7}

Side Effects

Statins have few side effects.

• The most common side effects are fatigue, upset stomach, gas, constipation, and abdominal pain or cramps.
• Liver enzymes called transaminases may rise slightly with statin treatment. Most of the time you do not need to stop taking the statin, unless the rise is 3 or more times their normal levels. Regular blood tests are needed to check liver function while taking statins.
• Muscle pain is a very rare side effect. Immediately report any severe muscle pain, weakness, or brown urine to your doctor, who may want to do a blood test. Muscle pain or weakness can be a sign of a severe muscle reaction (rhabdomyolysis) and should be evaluated by your doctor.

Cerivastatin (Baycol) has been voluntarily taken off the market by Bayer Pharmaceutical Division because of reports that it can cause rhabdomyolysis, a severe muscle reaction that can cause death. Most of the deaths have been among older adults who were receiving high doses of cerivastatin, especially when given with the medicine gemfibrozil (Lopid).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

These drugs do not cause side effects for most people who take them.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking a statin medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.⁸

No studies are available to confirm the long-term safety of statins.

Studies are focusing on combinations of statins and other medicines, such as nicotinic acids or fibric acid derivatives. These combination medicines are useful for lowering LDL and triglyceride levels. Statin and nicotinic acid combinations, such as the recently approved niacin/lovastatin (Advicor), may also raise beneficial HDL levels in people who are at risk for CAD because of low HDL.^{9, 10}

Some medicines can cause harm when taken with other medicines. People who are taking combination statin medicines should tell their doctors if they are taking other medicines to treat high cholesterol or triglycerides. Also, tell your doctor if you are taking antibiotics or antifungal drugs.

The side effects of statin medicines are more likely when higher doses are used.

Regular blood tests to check liver function are recommended, but the frequency of testing may decrease over time. However, people who are taking high doses of statins should be checked more frequently. People who have liver disease should talk to their doctors before taking these medicines.

People who are using statins should not take large amounts of niacin (a vitamin supplement) without telling their doctor.

Women who are pregnant or breast-feeding and anyone younger than 18 should not take statins.

Tell your doctor about all the medicines you are taking before using any medicine for the first time.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Ralph Poore	Last Updated July 20, 2006
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology
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