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The importance of statins to manage cholesterol

From Dr. Richard Chazal, a senior cardiologist and the Medical Director of Lee Health Heart and Vascular Institute, past president of the American College of Cardiology and incoming treasurer of the World Heart Federation. He is also designated a Master of the American College of Cardiology

For prevention of heart attacks in people with no known heart disease, some may require the use of medications. Such medications are virtually always recommended in persons with prior heart attacks or plaque in the heart arteries. The most common medications to manage high cholesterol are statins, which are documented to reduce the risk of heart attack in people at risk.

Statins come in the form of tablets and capsules. Some formulations of statins include:

Atorvastatin (Lipitor)
Fluvastatin
Lovastatin (Mevacor® or Altoprev™)
Pitavastatin (Livalo® or Zypitamag®)
Pravastatin
Rosuvastatin (Crestor® or Ezallor Sprinkle®)
Simvastatin (Flolipid® or Zocor®)

How Do Statins Help?

Statins decrease bad cholesterol (Low Density Lipoprotein or LDL). Additionally, this class of medications appears to decrease inflammation in the wall of arteries, which contributes to the buildup of plaque and to sudden events like heart attacks.

Where Does Cholesterol Come From?

Cholesterol is naturally manufactured by the body. In some cases, the amount or type of cholesterol can significantly increase the risk of heart attack (the leading cause of death for both men and women in the U.S.). Diet can also play a role. Most of the cholesterol that enters the body comes from food that’s high in saturated and trans fats. Some foods that can cause high cholesterol include red meat, butter, cheese, fried foods, egg yolks and many fast foods.

While diet can substantially reduce cholesterol levels in many people, some have genes that tell the body to make or absorb more cholesterol than is needed.

When Are Statins Prescribed?

Statins are recommended for people with LDL levels above 190 mg/dL after exercise and diet changes don’t work. Patients who’ve had a stroke, heart attack or peripheral artery disease are almost always prescribed statins regardless of the blood levels, as extensive scientific evidence shows a major benefit. Additionally, those with diabetes and an LDL of at least 70 mg/dL and people who are 40 to 75 years old typically take statins as well. For otherwise healthy adults, physicians use a risk calculator to determine the possible benefit, based on multiple factors including not only blood levels of cholesterol and LDL, but also other risk factors for heart disease.

What About the Risk of Statins?

This class of medications is among the most studied of all medical therapies. Serious side effects are rare, and are often the result of a combination with certain other drugs. Muscle aches are commonly reported, but in blinded studies (where the patient and physician are not aware of what is being taken), there is not a consistent increase in side effects compared to placebo pills. A slight risk in development of diabetes is present in some, but the benefit consistently outweighs the risk. Previous reports of deterioration in mental function have not been proven, and some studies suggest a reduction in such (though not clearly validated). For persons appropriately treated, the benefit of these medications consistently outweighs any risk.

When statins are needed, their use combined with healthy lifestyle choices, such as exercising regularly, not smoking, eating a balanced diet and getting enough sleep, it gives them a higher chance of working to the best of their ability.