Preventive Cardiology: Statins

Common Names

Lovastatin (Altoprev, Mevacor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Fluvastatin (Lescol)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)

Current Uses

Statins may be prescribed if you have:

High total cholesterol
High LDL ("bad") cholesterol
Low HDL ("good") cholesterol
High triglyceride levels
Coronary artery disease

If you already have cardiovascular disease, your doctor may recommend statins to reduce your risk of having a heart attack or stroke. Some people may benefit from a statin even if they have no history of cardiovascular disease but are at high risk.

Mechanism for How It Works

HMG-CoA reductase is an enzyme that helps your body make cholesterol. Statins help to block this enzyme, which in turn causes your body to make less cholesterol. When you make less cholesterol, your liver makes more LDL receptors, which attract LDL particles in the blood. This reduces the amount of LDL ("bad") cholesterol in your bloodstream. Lower LDL cholesterol levels also tend to lead to lower levels of triglycerides and higher HDL (“good”) cholesterol levels in the blood. Statins have anti-inflammatory effects on blood vessels which help reduce the formation of fatty plaque on blood vessel walls.

Side Effects

Statins can interact with many medicines. Below are some examples. But, you should talk to your doctor and pharmacist about the specific medicines that you are taking.

Cyclosporine (eg, Gengraf)
Erythromycin (eg, Erythrocin)
Gemfibrozil (eg, Lopid)
Nefazodone (eg, Serzone)
Verapamil (eg, Calan)
Digoxin (eg, Lanoxin)
Protease inhibitors to treat HIV, such as indinavir (eg, Crixivan), nelfinavir (eg, Viracept), ritonavir (eg, Norvir), saquinavir (eg, Invirase)

Statins can interact with certain foods, herbs, and supplements. Here are examples of potential interactions:

Grapefruit juice —increases the absorption of most statins, allowing potentially excessive levels to build up in the bloodstream
Chaparral, comfrey, and coltsfoot—may increase the risk of liver problems
St. John’s wort—may decrease blood levels of some statins
Vitamin B3— possibly increases the risk of developing a potentially fatal condition called rhabdomyolysis
Red yeast rice—contains a mixture of statins and should not be combined with statin drugs

If you would like to take herbs or supplements while taking a statin, check with your doctor first.

These conditions can affect how your body uses statins:

Allergy or intolerance to statins or allergies to other substances, including food
Obesity—can make statins less effective
Positive changes in diet and exercise—may need a lower dose

If you have any of the following conditions, tell your doctor before you are prescribed statins:

Alcohol abuse
Liver disease
Organ transplant and take medicine to prevent transplant rejection
Recent major surgery
Pregnant or breastfeeding—Statins are not recommended in pregnant or nursing women.

More common side effects include:

Gas
Upset stomach
Abdominal pain
Diarrhea
Constipation
Headache
Flu-like symptoms
Fatigue
Muscle pain
Skin rash

Less common, but more serious side effects include:

Liver problems
Myopathy (muscle weakness)
Rhabdomyolysis
Kidney failure
Memory problems and confusion
Increased blood sugar levels

Recommendations

Take only the amount of statin ordered by your doctor.
Do not stop taking this medicine without first checking with your doctor.
Tell your doctor or dentist about taking this medicine before having any kind of surgery, dental procedure, or emergency treatment.

Resources:

American Heart Association

http://www.heart.org/

US Food and Drug Administration

http://www.fda.gov/

Canadian resources:

Health Canada

http://www.hc-sc.gc.ca/index_e.html/

Heart and Stroke Foundation of Canada

http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.2796.../k.BF8B/Home.htm

References:

Amarenco P, Bogousslavsky J, Callahan A III, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-59.

Drug Therapy for Cholesterol. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM...5632_Article.jsp. Updated June 14, 2012. Accessed December 14, 2012.

Grundy SM, Cleeman JL, Merz CN et al. National Heart, Lung, and Blood Institute, American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Circulation. 2004;110:227-239.

Keeping cholesterol under control. US Food and Drug Administration website. Available at: http://www.fda.gov/. Accessed on January 28, 2003.

Lemaitre RN, Psaty B, Heckbert SR, et al. Therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults. Arch Intern Med. 2002;162:1395-1400.

Lipid-Lowering Pharmacotherapy Overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 3, 2012. Accessed December 14, 2012.

Middleton A, Binbrek AS, Fonseca FA, et al. Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis. Curr Med Res Opin. 2006;22: 1181-91.

Statins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 24, 2010. Accessed December 9, 2010.

Statins. United States Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrug...ss/ucm294358.htm. Updated November 21, 2012. Accessed December 14, 2012.

Statin Drugs. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthlibrary. Updated July 25, 2012. Accessed December 14, 2012.

Stender S, Schuster H, Barter P, et al. Comparison of rosuvastatin with atorvastatin, simvastatin, and pravastatin in achieving cholesterol goals and improving plasma lipids in hypercholesterolaemic patients with or without the metabolic syndrome in the MERCURY I trial. Diabetes Obes Metab. 2005;7:430-8.

Tahara N, Kai H, Ishibashi M, et al. Simvastatin attenuates plaque inflammation: evaluation by fuorodeoxyglucose positron emission tomography. J Am Coll Cardiol. 2006;48:1825-31.

1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol. 2008;52:1769-1781.

3/6/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnounce...ts/ucm293623.htm. Published February 28, 2012. Accessed March 6, 2012.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.