Statins have become the miracle medicine of modern heart care, lowering cholesterol levels and guarding against heart attacks in millions of Americans.
In fact, a running joke among doctors holds that statins are so helpful they should be put in the water supply.
However, they aren’t right for all patients, and some rare side effects can crop up with the meds, says Dr. Melissa Tracy, a cardiologist with Rush University Medical Center in Chicago.
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Here is a primer on what statins are, who should use them and what dangers they can pose to some patients.
What are statins?
Statins are medications that reduce blood levels of “bad” LDL cholesterol that can accumulate into plaques that clog arteries.
Statins can also reduce inflammation in patients, and might help lower blood pressure.
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People need a prescription to take statins, and most will take them for life once they start — even if their LDL cholesterol levels go down.
“I have had some patients that I can get off of a statin, but it tends to be one of those agents that we use lifelong,” Tracy said in a Rush news release.
Still, people on statins may need to stop taking them if they experience changes in liver function, become pregnant, start menopause or have other health changes, Tracy adds.
There are many different types of statins, and they are available both in generic and brand-name versions.
Who should take statins?
There are two main groups who should be taking statins, Tracy shares.
The first group is people who’ve already had a stroke or heart attack. For those patients, statins could prevent another heart-related health crisis from occurring, Tracy says.
The second group is people who’ve not had any problems with heart disease or clogged arteries, but are at elevated risk for developing a heart-related condition.
Patients in the second group might have a family history of heart disease, high cholesterol or other factors that put them at higher risk for heart issues, Tracy explains.
“Patients who have familial high cholesterol or those who have an LDL cholesterol greater than 160 and have not had a heart attack would be examples,” Tracy says.
A coronary calcium scan is a good way for otherwise healthy people to determine their heart health risk, Tracy says. It’s a simple imaging test that measures the cholesterol plaques in arteries that have built up and calcified.
It’s very important that people with calcified plaques in their arteries control their LDL cholesterol, Tracey says.
“We look to see if their coronary calcium score is zero. That’s what we want,” Tracy says. “Any score above zero indicates increasing risk for a heart attack.”
Hospitals and clinics offer coronary calcium screenings for as little as $49, Tracey notes.
At what age should I start statins?
Most people start taking statins in their 40s and 50s, but it really depends on a person’s individual risks, Tracy says.
“I would say in our 40s and 50s, we start to respect our mortality and we want to get on the bandwagon of being healthier,” Tracy says. “And most studies on statins are also in that age group.”
Your doctor might recommend you start earlier if you are at higher risk for heart health problems.
“I actually have patients in their 20s who have family members who have had strokes,” Tracy says.
“One young lady is a junior in college, and her mother has elevated cholesterol. But her mother’s brother has elevated cholesterol and had a stroke in his 40s. And this young lady has an abnormal lipid panel, despite her very healthy lifestyle,” Tracey adds. “So, now she takes a statin.”
Screenings for heart health risk, like calcium coronary scans, can help younger people figure out if they need to start statins earlier in life.
What tests are required before starting statins?
Doctors likely will want to prescribe statins based on test results, starting with a blood test to check your cholesterol levels.
The blood test will report your levels of “bad” LDL cholesterol, “good” HDL cholesterol and triglycerides. Triglycerides are fats that come from the food you eat, and a high number could mean greater risk.
A blood test for statin use also should measure blood levels of creatine kinase (CK).
CK is a muscle enzyme, and statins can cause its levels to spike and lead to muscles breaking down too quickly. A CK test taken before a person starts statins can help doctors detect such a spike.
Another important blood test before starting statins is a liver function test. Statins can cause liver irritation and might not be a good choice for people who already have liver problems.
Patients likely will need to repeat some of these tests about a month after starting statins, to monitor any changes. They’ll also need to take the tests again if their dosage changes, as well as annual check-up tests.
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If I’m on statins, do I still need to work out and eat right?
Statins are not wonder drugs that allow a person to skip exercise and gorge on junk food, Tracy says.
The drugs can help prevent heart problems, but they are only one piece of the larger puzzle.
“I urge patients to implement diet, exercise and weight loss,” Tracy says. “We know that by aggressive diet, exercise and weight loss, we can lower LDL cholesterol by about 20 percent.”
But lowering LDL cholesterol by that much takes a very strict diet and an intense exercise regimen, Tracy acknowledges.
“So, I still couple starting a statin with diet and exercise and weight loss. Absolutely,” Tracy says. “To me, that has to be a happy marriage of two partners.”
Who shouldn’t take statins?
Statins tend to be fairly harmless and helpful, but they aren’t for everyone.
People who should not take statins, or who at least should discuss it with their doctor, include:
- Women who are pregnant or trying to become pregnant
- People with liver disease or poor liver function
- People who have diseases that cause muscle breakdown
- Elderly patients
Are there any health risks for statins?
The most common side effects are muscle aches, joint aches and fatigue. Others include liver irritation or rare conditions that trigger muscle breakdown.
Some have claimed that statins cause dementia, but Tracy says this connection has so far only been anecdotal. Studies have not yet found any significant link between statins and dementia, despite individual cases reporting such an association.
A more substantial concern involves a link between statins and diabetes, Tracy notes.
“The connection of statins with diabetes is a bit stronger,” Tracy says. “But for those patients that we have on statins, we have to do the risk versus benefit for the very low chance of developing diabetes and the high positive benefit on their coronary or cerebral circulation.”
People on statins should talk to their doctor about any side effects they think they are experiencing. Doctors can adjust the dosage, try a different statin, or even prescribe an alternative to statins.
