Statins and cholesterol overview
Statins, also known as HMG-CoA reductase inhibitors, are highly effective cholesterol-lowering medications. Statins have been studied extensively and overall have been proven to decrease the risk of heart attack, stroke, and other coronary artery diseases that are related to high cholesterol levels.
Statins, which are medications available only by prescription, are only considered after certain lifestyle changes have been made. These lifestyle changes include the following:
* Low-saturated fat, low-cholesterol diet
* Increased physical activity
* Smoking cessation
* Weight loss
If these changes have not lowered your risk for developing coronary heart disease after about 3 months, your doctor may consider prescribing a statin. If this medication is prescribed, the above lifestyle changes must still be followed. Results are usually seen after 4-6 weeks of taking statins.
Commonly prescribed statins include the following:
* Atorvastatin (Lipitor)
* Fluvastatin (Lescol)
* Lovastatin (Mevacor, Altocor)
* Pravastatin (Pravachol)
* Simvastatin (Zocor)
* Rosuvastatin (Crestor)
Statins come in tablet or capsule forms and are usually taken with the evening meal or at bedtime.
For more about medications used to lower cholesterol, see Understanding Cholesterol-Lowering Medications.
How do statins work?
Statins inhibit the enzyme HMG-CoA reductase, which controls the rate of cholesterol production in the body. These drugs lower cholesterol 20-60% by slowing the production of cholesterol and by increasing the liver's ability to remove the “bad” cholesterol (low-density lipoprotein, or LDL) already in the blood. Statins lower LDL cholesterol levels more effectively than other types of drugs do. They also modestly increase the “good” cholesterol (high-density lipoprotein, or HDL) and decrease total cholesterol and triglycerides.
Who should not use these medications?
You should not use statins if you fit any of the following situations:
* You are allergic to statins or their ingredients.
* You are pregnant or planning a pregnancy.
* You are breastfeeding.
* You have active liver disease.
* You excessively consume alcohol.
* You have a history of myopathy (a type of muscle disease).
* You have renal failure due to rhabdomyolysis.
Drug or food interactions
Consuming large quantities of grapefruit juice, more than 1 quart per day, decreases the ability of the liver to metabolize some statins (for example, atorvastatin, simvastatin, and lovastatin). Also, and possibly more importantly, statins and certain other medications can interact, causing serious side effects. Tell your doctor about any prescription and nonprescription medications you are taking, including the following:
* Vitamins
* Herbal supplements
* Medication for your immune system, such as drugs prescribed following organ transplantation
* Other cholesterol medications, such as fibrates or nicotinic acid
* Medication for infections, such as erythromycin, clarithromycin, itraconazole, or ketoconazole
* Birth control pills
* Medication for heart failure
* Medication for HIV or AIDS
* Warfarin (Coumadin) (Warfarin may have an increased effect when administered with rosuvastatin or simvastatin. International normalized ratio [INR] must be closely monitored when warfarin is administered with statins.)
