Features April 2009 Issue

What You Need to Know About Statins

Statins are the most commonly-prescribed drug and have revolutionized heart health.

Data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) indicates that 33.5 million older Americans take statins, and it’s thought another 11 million also could benefit from taking them. The drugs are proven to reduce the incidence of heart attacks, strokes and death in patients with established coronary artery disease (CAD). Recent research, published in the Feb. 9 issue of Archives of Internal Medicine, suggests they also may be useful in delaying or preventing the development of CAD in patients who have not yet been diagnosed.

Statins—which include atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor)—lower LDL ("bad") cholesterol by blocking a specific liver enzyme (HMG Co-A reductase) which controls cholesterol production by the liver. Cholesterol, a waxy, fat-like substance that’s vital for cell function, is harmful if elevated because high levels can result in a condition called atherosclerosis, where fatty deposits called plaque narrow and even block the arteries. Atherosclerosis impedes the flow of blood to the heart, which may result in angina (chest pain). If plaque ruptures, blood clots can form, raising the risk of heart attack and stroke. As well as helping prevent a buildup of plaque by lowering cholesterol levels, statins also reduce inflammation (an important factor in cardiovascular disease) and may help the body to reabsorb cholesterol that has already been deposited in plaque.

Possible Side Effects

Statins are well tolerated by most people, but about 15 percent of patients report side effects. The most common are weakness and pain in the muscles and joints, which usually resolve if the dose is lowered or the patient stops taking the medications. Headaches, dizziness and a rash also may occur. There is anecdotal evidence that statins may also have cognitive side effects such as memory loss, particularly in women, but studies have demonstrated no causal link.

Important Precautions

Certain drugs block the action of other liver enzymes that enable the liver to process and eliminate specific statins, and this can cause a buildup that may result in a condition called rhabdomyolysis. This causes muscle fibers to break down and travel to the kidneys via the bloodstream, potentially causing kidney damage. Drugs that can cause this interaction include some AIDS, medications, the antibiotics erythromycin (ERY-C), clarithromycin (Biaxin), the calcium-channel blocker diltiazem (Cardizem, Dilacor), and the heart medication verapamil (Calan, Isoptin). Statins also interact with some other cholesterol-lowering drugs, which should be taken strictly as directed to lower the risk of interactions.

Avoid drinking grapefruit juice if you take statins as it may prevent the liver from sufficiently breaking down the drug, resulting in a higher dose entering the bloodstream.

Alternatives

Other cholesterol-lowering drugs include niacin (Niacor, Niaspan), fibric acid-based drugs such as gemfibrozil (Lopid) and fenofibrate (Tri-Cor), and ezetimibe (Zetia). These may be used in combination with statins, and if so, the risk of interactions is raised if you do not take your meds as directed.

Lifestyle modifications such as weight loss, a diet high in fruit and vegetables, whole grains, oily fish, and nuts and foods low in saturated fat (found in red meat and full-fat dairy) and trans fats (present in many baked goods and fast food) can lower cholesterol and reduce the need for medications. Dietary supplements reported to lower cholesterol include red yeast rice, but many "natural" remedies interact with conventional medications, so consult your doctor before taking them.