Statins are phenomenally effective in reducing heart attacks and strokes, as well as the deaths they cause. Statins do it by lowering levels of “bad” LDL cholesterol in the blood, which prevents plaque from building up in artery walls. That’s why many doctors recommend their patients take advantage of statintherapy.
Overall, statins are generally well tolerated. However, a small percentage of patients experience side effects—generally muscle pain or muscle weakness. People with underlying muscle or gallbladder disease are at increased risk of statin-induced muscle aches. So are people who drink alcohol while taking a statin.
Cleveland Clinic cardiologist Leslie Cho, MD, a world expert on statin intolerance, says there are three things you should try to ward off or minimize these problems, so you can continue taking advantage of these beneficial drugs.
1. Check for Medication Interactions
First, make sure that no other medication you take is causing statin intolerance. Many common antibiotics and antifungal medications, the hypertension drugs diltiazem and verapamil, and the antiarrhythmia medications amiodarone and digoxin are known to interact with statins.
“These drugs cause statins to linger in the body, which can trigger symptoms,” says Dr. Cho.
2. Try a Different Statin
Ask your doctor if you should change statins. The hydrophilic statins—pravastatin (Pravacol), rosuvastatin (Crestor) and fluvastatin (Lescol)—are less likely to affect the muscles than the other four statins.
Dr. Cho advises her patients to stop the offensive statin for two to four weeks, then start a different statin. In a Cleveland Clinic study, 70 percent of patients could tolerate the second statin. In a different study, 92 percent of patients were still taking the second statin a year later.
3. Try a Different Dosing Regimen
Since a little statin is better than no statin at all, start with the lowest dose of a hydrophilic statin once a week. Gradually move to twice a week, then to three times a week. “Give yourself time to assess how well you tolerate the medication and how it affects your cholesterol,” says Dr. Cho.
If you can tolerate statin therapy one, two or three times a week, but it’s not enough to help you reach your desired LDL goal, consider adding a non-statin lipid-lowering agent, such as ezetimibe (Zetia).
If these tactics don’t work, switch to a different class of drugs
If you simply can’t take statins, try an entirely different type of drug.
Bile acid sequestrants are an option. However, you may need to add ezetimibe to lower cholesterol levels enough to be beneficial.
One of the new PCSK9 inhibitors, evolocumab (Repatha) or alirocumab (Praluent), may be a better bet, although they remain much more expensive than other cholesterol-lowering medications. “These drugs have been used successfully in patients with statin intolerance without exacerbating symptoms,” says Dr. Cho.
Don’t Give Up
Of course, you should not try any of these measures without consulting your doctor first. But these tactics provide a good chance you’ll be able to take a statin without experiencing side effects unpleasant enough that you need to discontinue the medication.
“Stopping statin therapy is not a good idea, since it greatly increases the chance of having a heart attack,” says Dr. Cho. “Don’t give up until you’ve tried all options.”
Don’t Be Afraid of Statins
Be wary of rumors about these drugs.
Perhaps no drugs have been as well studied—or as frequently maligned—as statins.
Steven Nissen, MD, Cleveland Clinic’s Chairman of Cardiovascular Medicine, blames unsubstantiated rumors that feed people’s fears.
“The Internet is full of articles suggesting statins have really serious adverse effects, and that people shouldn’t take them,” he says. “Many of these articles promote so-called ‘natural’ dietary supplements that are supposed to lower cholesterol or prevent heart attacks, or diets that supposedly eliminate heart disease. But none of these have any scientific basis. No dietary supplement or special diet has been shown to reverse heart disease.”
What Has Been Proven About Statins
Over the years, statins have been proven to offer the following benefits:
– Statins reduce fatal and nonfatal heart attacks, strokes and need for revascularization in men and women alike. Every 40 mg/dL reduction in LDL achieved with statins is associated with a 19 percent reduction in cardiac death and 12 percent reduction in death from all causes and fewer strokes, heart attacks and revascularizations.
– Statins are fundamentally safe. Rhabdomyolysis, a serious side effect that causes muscle tissue breakdown, is extremely rare. Reports of memory loss and liver damage from statin therapy have never been substantiated.
– Statins usually lower LDL cholesterol by 20 to 60 percent, total cholesterol by 16 to 45 percent and triglycerides by 25 to 30 percent in several weeks.
– Two statins—rosuvastatin (Crestor) and atorvastatin (Lipitor)—have been shown to reverse cholesterol buildup in the coronary arteries.
“These are the facts, and they speak for themselves,” says Dr. Nissen. “Don’t let hearsay stop you from using statins to lower your cardiovascular risk.”