Statins: Are these cholesterol-lowering drugs right for you? - Mayo Clinic Statins: Are these cholesterol-lowering drugs right for you? Statins: Are these cholesterol-lowering drugs right for you? Find out whether your risk factors for heart disease make you a good candidate for statin therapy. By Mayo Clinic Staff Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks. Statins include medications such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Lower-cost generic versions of many statin medications are available. Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What kinds of side effects may occur?

Can statins help prevent other diseases? Should you be on a statin? Whether you need to be on a statin depends on your cholesterol level, along with your other risk factors for cardiovascular disease. Most people should try to keep their total cholesterol level below 200 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L). Low-density lipoprotein cholesterol (LDL, or "bad" cholesterol) should be below 100 mg/dL (3.37 mmol/L). But the numbers alone won't tell you or your doctor the whole story. High cholesterol is only one of a number of risk factors for heart attack and stroke. The most important factor to consider is a person's long-term risk of experiencing a heart attack or stroke. If the risk is very low, there is probably no need for statins, unless the LDL is above 190 mg/dL (4.9 mmol/L). If the risk is very high — for example, someone who has had a heart attack in the past — the person may benefit from statins, even if his or her cholesterol is not elevated.

Risk assessment tools Your doctor may suggest using an online tool to better understand your long-term risks of developing heart disease. The American College of Cardiology and the American Heart Association have recently developed an online tool to predict a person's chances of having a heart attack in the next 10 years. For people under the age of 50, the Framingham cardiovascular disease risk calculator might be a better option because it provides a 30-year risk prediction. In addition to your cholesterol numbers, these risk calculators also ask about your age, race, sex, blood pressure and whether you have diabetes or smoke cigarettes. New cholesterol guidelines New guidelines from the American College of Cardiology and American Heart Association focus on four main groups of people who may be helped by statins: People who already have cardiovascular disease. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, mini-strokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries. People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher. People who have diabetes.

This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease. People who have a higher 10-year risk of heart attack. This group includes people who have an LDL above 100 mg/dL (1.8 mmol/L) and whose 10-year risk of a heart attack is 7.5 percent or higher. Lifestyle is still key for preventing heart disease Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. To reduce your risk: Quit smoking and avoid secondhand smoke Eat a healthy diet that's low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains. Be physically active, sit less and exercise regularly Maintain a healthy waist girth: less than 40 inches in men and less than 35 inches in women If you're following the recommended lifestyle behaviors but your cholesterol — particularly your LDL (bad) cholesterol — remains high, statins might be an option for you.

Risk factors for heart disease and stroke are: Smoking Diabetes Being overweight or obese Family history of heart disease, especially if it was before the age of 55 in male relatives or before 65 in female relatives Not exercising Poor stress and anger management Older age Rosenson RS. Statins: Actions, side effects, and administration. Accessed March 23, 2015. Drug therapy for cholesterol. American Heart Association. Accessed March 23, 2015. AskMayoExpert. Hyperlipidemia: What are the newly released American College of Cardiology and American Heart Association guidelines on heart disease prevention (including new guidelines for treatment of cholesterol abnormalities) and what are Mayo's recommendations in response to these new guidelines? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. Rosenson RS. Statins: Possible noncardiovascular benefits. Accessed March 23, 2015. Levels of cholesterol. American Heart Association. Accessed March 24, 2015. Rosenson RS. Treatment of lipids (including hypercholesterolemia) in secondary prevention.

Accessed March 24, 2015. What are coronary heart disease risk factors? National Heart, Lung, and Blood Institute. #. Accessed March 25, 2015. Hennekens CH. Overview of primary prevention of coronary heart disease and stroke. Accessed March 25, 2015. FDA expands advice on statin risks. U.S. Food and Drug Administration. Accessed March 25, 2015. Rosenson RS, et al. Statin myopathy. Accessed March 25, 2015. Opie LH. Present status of statin therapy. Trends in Cardiovascular Medicine. 2015;25:216. Lopez-Jimenez F (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2015. Products and Services FDA Expands Advice on Statin Risks FDA Expands Advice on Statin Risks If you’re one of the millions of Americans who take statins to prevent heart disease, the Food and Drug Administration (FDA) has important new safety information on these cholesterol-lowering medications.

FDA is advising consumers and health care professionals that: Routine monitoring of liver enzymes in the blood, once considered standard procedure for statin users, is no longer needed. Such monitoring has not been found to be effective in predicting or preventing the rare occurrences of serious liver injury associated with statin use. Cognitive (brain-related) impairment, such as memory loss, forgetfulness and confusion, has been reported by some statin users. People being treated with statins may have an increased risk of raised blood sugar levels and the development of Type 2 diabetes. Some medications interact with lovastatin (brand names include Mevacor) and can increase the risk of muscle damage. This new information should not scare people off statins, says Amy G. Egan, M.D., M.P.H., deputy director for safety in FDA’s Division of Metabolism and Endocrinology Products (DMEP). “The value of statins in preventing heart disease has been clearly established,” she says. “Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects.” FDA will be changing the drug labels of popular statin products to reflect these new concerns.

(These labels are not the sticker attached to a prescription drug bottle, but the package insert with details about a prescription medication, including side effects.) The statins affected include: back to top Liver Injury Called Rare FDA has found that liver injury associated with statin use is rare but can occur. Patients are advised to consult their health care professional if they have symptoms that include unusual fatigue, loss of appetite, right upper abdominal discomfort, dark urine or yellowing of the skin or whites of the eyes. Statins work in the liver to reduce the production of cholesterol, a waxy substance that can form plaque on the walls of the arteries and keep the heart from getting the blood it needs. Egan explains that there had been signals in early clinical trials of possible liver damage tied to statin use, so health care professionals were advised to regularly test their patients’ liver enzyme levels. However, she says, such damage is rare, and the tests are not effective at predicting or preventing who will develop this rare side effect. So FDA is now recommending that liver enzyme tests be performed before statin treatment begins and then as needed if there are symptoms of liver damage. back to top Reports of Memory Loss FDA has been investigating reports of cognitive impairment from statin use for several years.

The agency has reviewed databases that record reports of bad reactions to drugs and statin clinical trials that included assessments of cognitive function. The reports about memory loss, forgetfulness and confusion span all statin products and all age groups. Egan says these experiences are rare but that those affected often report feeling “fuzzy” or unfocused in their thinking. In general, the symptoms were not serious and were reversible within a few weeks after the patient stopped using the statin. Some people affected in this way had been taking the medicine for a day; others had been taking it for years. What should patients do if they fear that statin use could be clouding their thinking? “Talk to your health care professional,” Egan says. “Don’t stop taking the medication; the consequences to your heart could be far greater.” back to top The Risk of Diabetes Diabetes occurs because of defects in the body’s ability to produce or use insulin—a hormone needed to convert food into energy. If the pancreas doesn't make enough insulin or if cells do not respond appropriately to insulin, blood sugar levels in the blood get too high, which can lead to serious health problems.

A small increased risk of raised blood sugar levels and the development of Type 2 diabetes have been reported with the use of statins. “Clearly we think that the heart benefit of statins outweighs this small increased risk,” says Egan. But what this means for patients taking statins and the health care professionals prescribing them is that blood-sugar levels may need to be assessed after instituting statin therapy,” she says. back to top The Potential for Muscle Damage Some drugs interact with statins in a way that increases the risk of muscle injury called myopathy, characterized by unexplained muscle weakness or pain. Egan explains that some new drugs are broken down (metabolized) through the same pathways in the body that statins follow. This increases both the amount of statin in the blood and the risk of muscle injury. FDA is revising the drug label for Lovastatin to clarify the risk of myopathy. The label will reflect what drugs should not be taken at the same time, and the maximum lovastatin dose if it is not possible to avoid use of those other drugs. Patients and health care professionals should report negative side effects from statin use to FDA’s MedWatch Adverse Event Reporting Program .

This article appears on FDA's Consumer Update page , which features the latest on all FDA-regulated products. Updated: January 31, 2014 Statins Lower Blood Pressure Statins Lower Blood Pressure By Kelley Colihan From the WebMD Archives April 11, 2008 -- Chalk up another potential benefit to taking statins . A newly released study shows that the cholesterol -lowering drugs also help to lower blood pressure . Study authors say it's the first time research has shown that statins work this way in the body. Researchers looked at 973 men and women in southern California. The participants had no known heart disease or diabetes . Participants were given either Zocor , Pravachol , or a placebo every day for six months. Statins and Blood Pressure People who took either one of the two statin drugs had a "modest, but significant" reduction of blood pressure when compared with the group who took a placebo pill.

"We found that statins lower both systolic and diastolic blood pressure, and that the effect extends to patients with pre- hypertension , with normal blood pressure, and persons not on blood -pressure lowering medications ," according to a news release from study researcher Beatrice Golomb, MD, PhD. Golomb is with the University of California, San Diego School of Medicine. Statins are one of the best-selling prescribed drugs in the world, used mainly to treat high cholesterol . But physicians have long observed that the health benefits obtained from statin use seem to be more rapid than could be explained from the effects of these medications on plaque accumulation. The blood pressure reduction effect could prove to be part of the answer. Lower blood pressure is linked to lower stroke risk. Study authors suspect that one of the ways the use of statins is helpful in reducing stroke is through the blood pressure effect. Golomb and her team recommend more research, looking into how different types of statins might work, plus how different dosages and a longer treatment time may affect blood pressure. The study is published in the April 14 edition of the journal Archives of Internal Medicine.

WebMD Health News Reviewed by Elizabeth Klodas, MD, FACC on April 11, 2008 Sources Statins: Uses, Side Effects, and Risks - Medical News Today Statins: Uses, Side Effects, and Risks Written by Peter Crosta MAReviewed by Alan Carter, PharmD 4 12 Statins are a class of medicines that are frequently used to lower blood cholesterol levels. They do this by blocking the action of a specific chemical in the liver that is necessary for making cholesterol. Although cholesterol is necessary for normal cell and body function, very high levels of it can lead to atherosclerosis, a condition where cholesterol-containing plaques build up in arteries and block blood flow. By reducing blood cholesterol levels, statins lower the risk of chest pain ( angina ), heart attack, and stroke. In this article, we will look at how statins work, who uses them, and the associated risks and benefits. Contents of this article: Fast facts on statins Here are some key points about statins. More detail and supporting information is in the main article.

Statins are used to lower cholesterol levels in the blood Statins work by inhibiting an enzyme called HMG-CoA reductase People with atheroma-related disease, diabetes , and a family history of heart attacks are often prescribed statins People with liver disease should avoid statins What are statins? Statins are a type of medication that blocks the action of an enzyme in the liver that helps produce cholesterol. They are typically prescribed to lower blood cholesterol levels. Types of statins include: Rosuvastatin Simvastatin Atorvastatin and rosuvastatin are the most potent while fluvastatin is the least potent. These medicines are sold under several different brand names, including Lipitor (an atorvastatin), Pravachol (a pravastatin), Crestor (a rosuvastatin), Zocor (a simvastatin), Lescol (a fluvastatin), and Vytorin (a combination of simvastatin and ezetimibe). Mevastatin is a naturally occurring statin found in red yeast rice. Research into statins over the last few years has uncovered additional benefits , other than those based on cardiovascular outcomes.

For instance, researchers from the Mayo Clinic, MN, carried out a study demonstrating that statins might reduce people's risk of developing esophageal cancer (cancer of the gullet). A report published in the journal Circulation: Cardiovascular Quality and Outcomes concluded that overall, the benefits of statins largely outweigh the risks associated with the medication. How do statins work? Statins work by inhibiting a specific enzyme in the liver. Statins inhibit an enzyme called HMG-CoA reductase, which controls cholesterol production in the liver. The medicine blocks the active site of the enzyme, preventing other molecules from activating it, thereby slowing down the cholesterol production process. Additional enzymes in the liver cell sense that cholesterol production has decreased and respond by creating a protein that leads to an increase in the production of LDL (low-density lipoprotein, or "bad" cholesterol) receptors. These receptors relocate to the liver cell membranes and bind to passing LDL and VLDL (very low-density lipoprotein). The LDL and VLDL then enter the liver and are digested. People often begin statin treatment to lower their cholesterol level to below 5 millimoles per liter, or by 25-30 percent.

The dosage may be increased if this target is not reached. Treatment with statins usually continues even after the target cholesterol level is reached to continue the protection against atherosclerosis . Who takes statins? Statins are usually prescribed for individuals with the following conditions : Atheroma-related diseases such as heart disease and atherosclerosis. Statins reduce the chance that these conditions will worsen and can delay their progression Diabetes or another disease that increases the risk of developing an atheroma-related disease A family history of heart attacks (especially at a young age) Increasing age A high cholesterol level is the most common reason that a person is prescribed statins, but the drugs also reduce heart diseases by preventing atherosclerosis. In fact, it is possible to have a heart attack without high blood cholesterol levels, but nearly all heart attacks begin with atherosclerosis plaque buildup. Plaques from atherosclerosis can still form even when blood cholesterol is low. Therefore, statins may be used to treat people who already have atherosclerosis or are at a higher risk of developing it, even if they do not have high cholesterol levels.

Statins plus exercise usually better than statins alone Researchers from the Veterans Affairs Medical Center, Washington DC, published a paper in The Lancet titled "Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study." They found that for people with dyslipidemia (irregular levels of dangerous cholesterol/blood fats), the combination of taking statin medications and doing exercise is usually more effective in preventing early death than either intervention alone. Exercise alone, however, for those with dyslipidemia, is better than taking no statin and doing no exercise. The authors found that those who do not take statins but are physically fit are half as likely to die an early death compared with unfit people with dyslipidemia who take no medication. Side effects of statins Individuals with liver disease should avoid statins. Although most people who take statins have minor or no side effects , many can suffer from headache, pins and needle sensations, abdominal pain, bloating, diarrhea, feeling sick, and a rash. The two most serious side effects - both of which occur relatively rarely - are liver failure and skeletal muscle damage. The muscle damage is a severe type of myopathy called rhabdomyolysis .

Rhabdomyolysis usually begins as muscle pain and can worsen to such an extent that the patient loses all muscle cells, experiences kidney failure, or dies. The condition is more common when statins are used in combination with other drugs that carry high rhabdomyolysis risk, or with other drugs that raise the statin levels in the blood. People with active liver disease should not take statins. If liver disease develops while taking statins, usage should be stopped. Also, pregnant and breast-feeding women , or those intending to become pregnant, should not take statins. It is generally recommended that people taking statins should not combine them with the following medications: Protease inhibitors (AIDS treatment) Verapamil Fibrate drugs (that also lower LDL levels) Some statin drugs may impair memory - researchers at the University of Bristol in England found that two commonly prescribed statins - pravastatin (Pravachol) and atorvostatin (Lipitor) - reduced performance of recognition and working memory in an animal experiment. Statins may also raise the risk of developing cataracts .

A research team at the San Antonio Military Medical Center, TX, reported in JAMA Ophthalmology that statin usage increased the risk of cataracts by 27 percent . People who are taking statins should avoid grapefruits and grapefruit juice due to the potentially dangerous effects of an interaction. Statins may slow down the aging process Researchers at the Second University of Naples, Italy, found that statins may slow aging . Statins may reduce the rate at which telomeres shorten. Telomeres are tails of repetitive DNA sequences at the ends of a chromosomes; they protect the code from deterioration. As we get older, telomeres get shorter, limiting the number of cells that can divide; this causes cellular aging. In a study involving 203 participants, the researchers found that those who were taking statins had higher levels of telomerase activity in their white blood cells, resulting in less telomere shortening, compared with those not taking statins. Lead researcher, Giuseppe Paolisso, said "By telomerase activation, statins may represent a new molecular switch able to slow down senescent cells in our tissues and be able to lead healthy lifespan extension.

If it is confirmed that statins might actually slow aging itself, and not just the symptoms of aging, then statins are much more powerful drugs than we ever thought." For more information on the harms and benefits of statins, see our article: Are Statins Good Or Bad? Written by Peter Crosta MA Click the stars to rate this article Statins: Uses, Side Effects, and Risks Public / Patient Cholesterol Medications Cholesterol Medications Updated:Aug 24,2016 If you are concerned about preventing or treating unhealthy cholesterol levels , you should make diet and lifestyle changes . For some people, diet and lifestyle changes may be enough. For others, medication may also be needed. Your doctor can assess your risk for a heart attack or stroke based on your cholesterol levels and other risk factors. From there, you can work with your doctor to develop a treatment and prevention plan that's right for you. Cholesterol-Lowering Drugs Various medications can lower blood cholesterol levels. Statins are recommended for most patients because they are the only cholesterol-lowering drug class that has been directly associated with reduced risk for heart attack and stroke.

Your doctor may consider other medications as well, especially if you have serious side effects or don’t have an adequate response to statin therapy alone. The guidelines recommend people talk to their doctor about the risks and benefits of statin therapy if they fall into one of the following groups: Adults with LDL (bad) cholesterol of 70-189 mg/dL and a 7.5 percent or higher risk for having a heart attack or stroke within 10 years. People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization). People 21 and older who have a very high level of LDL (bad) cholesterol (190 mg/dL or higher). People with diabetes and a LDL (bad) cholesterol level of 70-189 mg/dL who are 40 to 75 years old. Some patients who do not fall into these four major categories may also benefit from statin therapy. Any decision about treatment should be the result of you working with your doctor to decide the best preventive strategy. View an animation to see how cholesterol drugs work .

*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products. If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information. It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor. *Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your health care provider about any potential risks. Learn more about cholesterol drugs Statins (also known as HMG CoA reductase inhibitors) This class of drugs works in the liver to prevent the formation of cholesterol, thus lowering the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol, but also have modest effects on lowering triglycerides (blood fats) and raising HDL (good) cholesterol.

Most side effects are mild and generally go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. Patients who are pregnant or who have active or chronic liver disease should not take statins. Talk to your doctor about the possible side effects of statins before starting the drug. Statins currently available in the U.S. include: Atorvastatin (Lipitor®)** Rosuvastatin Calcium (Crestor®)** Simvastatin (Zocor®)** Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe). This class of drugs works in the liver to prevent the formation of cholesterol, thus lowering the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol, but also have modest effects on lowering triglycerides (blood fats) and raising HDL (good) cholesterol. Most side effects are mild and generally go away as your body adjusts.

Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. Patients who are pregnant or who have active or chronic liver disease should not take statins. Talk to your doctor about the possible side effects of statins before starting the drug. Statins currently available in the U.S. include: Atorvastatin (Lipitor®)** Rosuvastatin Calcium (Crestor®)** Simvastatin (Zocor®)** Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe). Selective cholesterol absorption inhibitors This relatively new class of cholesterol-lowering medications works by preventing the absorption of cholesterol from the intestine. Selective cholesterol absorption inhibitors are most effective at lowering LDL (bad) cholesterol, but may also have modest effects on lowering triglycerides (blood fats) and raising HDL (good) cholesterol. The first medication of this class, ezetimibe (Zetia®)**, was approved in 2002 for the treatment of high cholesterol and certain inherited lipid abnormalities.

Resins (also known as bile acid sequestrant or bile acid-binding drugs) This class of LDL-lowering drugs works in the intestines by promoting increased disposal of cholesterol. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so it can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream. Resins currently available in the U.S. include: Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)** Colestipol (Colestid®)** Lipid-Lowering Therapies Fibrates (fibric acid derivatives): Fibrates are best at lowering triglycerides and in some cases increasing HDL (good cholesterol) levels. These drugs are not very effective in lowering LDL (bad) cholesterol. Fibrates currently available in the U.S.

include: Gemfibrozil (Lopid®)** Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)** Clofibrate (Atromid-S)** This drug works in the liver by affecting the production of blood fats. Niacin side effects may include flushing, itching and stomach upset. Your liver functions may be closely monitored, as niacin can cause toxicity. Nonprescription immediate release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients as it can raise blood sugar levels. Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin. It should not be used for lowering cholesterol because of potential serious side effects. Dietary supplement niacin is not regulated by the Food and Drug Administration. It may contain widely variable amounts of niacin — from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy.

Omega-3 Fatty Acid Ethyl Esters These medications are derived from fish oils that are chemically changed and purified. They are intended to be used in addition to diet to lower triglycerides in individuals with very high triglyceride (levels over 500 mg/dL). Omega-3 fatty acid ethyl esters may cause serious side effects and interact negatively with other medications, herbal preparations and nutritional supplements. Individuals with allergies/sensitivities to fish and/or shellfish and/or any other drug component(s) may have a severe adverse reaction to use of these medications. Omega-3 fatty acid ethyl esters available in the U.S. include: Lovaza® Controlling Cholesterol with Statins Controlling Cholesterol with Statins Tips for Consumers When it comes to keeping your heart healthy, what foods you eat and the genes you inherit matter. Good heart health also may depend on the drugs you take. Several medicines are effective at lowering blood cholesterol levels—a key factor in good heart health. Chief among them are the statins. Statins (HMG-CoA reductase inhibitors) are one class of many drugs used to lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver.

Statins block the enzyme in the liver that is responsible for making cholesterol. Too much cholesterol can increase a person's chance of getting heart disease. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both women and men in the United States. back to top Understanding Cholesterol Cholesterol is a waxy substance found in all parts of the body. It is critical to the normal function of all cells. The body needs cholesterol for making hormones, digesting dietary fats, building cell walls, and other important processes. Your body makes all the cholesterol it needs, but cholesterol is also in some of the foods you eat. When there is too much cholesterol in your blood, it can build up on the walls of the arteries (blood vessels that carry blood from the heart to other parts of the body). This buildup is called plaque. Over time, plaques can cause narrowing or hardening of the arteries—a condition called atherosclerosis. In short, too much cholesterol can clog your arteries and keep your heart from getting the blood it needs. back to top Cholesterol Numbers That Matter There are no warning symptoms of high cholesterol. But a simple blood test by your doctor will measure the different kinds of cholesterol.

Low-density lipoprotein (LDL) or "bad" cholesterol can clog the arteries. Lower numbers of LDL are best. The higher the LDL level, the greater the risk for heart disease. High-density lipoprotein (HDL) or "good" cholesterol carries bad cholesterol out of your blood, back to the liver, where it can be eliminated, to keep it from building up in the arteries. The higher the HDL level, the lower the risk for heart disease. For information on what your cholesterol numbers mean, visit #numbers What Affects Cholesterol? The following factors affect blood cholesterol levels: Certain foods - eating too much saturated fat, found mostly in animal products, and too much cholesterol, found only in animal products Heredity - genes play a role in influencing the levels Weight - excess weight tends to increase the levels Exercise - regular physical activity may not only lower LDL cholesterol, but it may increase the level of desirable HDL cholesterol Smoking - cigarette smoking lowers HDL cholesterol Age and gender - cholesterol levels naturally rise as men and women age. Menopause is often associated with increased LDL cholesterol in women.

back to top State of the Statins The main goal of cholesterol treatment is to lower LDL to levels that will not lead to or worsen heart disease. When a patient without heart disease is first diagnosed with elevated blood cholesterol, the National Cholesterol Education Program guidelines advise a six-month program of reduced dietary saturated fat and cholesterol, together with physical activity and weight control, as the primary treatment to bring levels down. When diet and exercise alone are not enough to reduce cholesterol to goal levels, doctors often prescribe medication—the most prominent being the statins. By interfering with the production of cholesterol, statin medications can slow the formation of plaques in the arteries. Statins are relatively safe for most people, but some can respond differently to the drugs. Certain people may have fewer side effects with one statin drug than another. Some statins, in particular Lovastatin and Simvastatin, also are known to interact adversely with other drugs. This information, coupled with the degree of cholesterol-lowering desired, will help guide the decision about which statin to use, or whether another type of drug should be used.

Statin medications (HMG-CoA reductase inhibitors) work in the liver to prevent formation of cholesterol are effective in lowering bad cholesterol levels and raising good cholesterol are not recommended for pregnant patients or those with active or chronic liver disease can cause serious muscle problems Currently available statins Statins: Cholesterol and Lipid-Lowering Drugs What are some examples of statins approved by the FDA in the U.S.? What are statins and how do they work? Statins (or HMG-CoA reductase inhibitors) are a class of drugs that reduce cholesterol in individuals who have dyslipidemia (abnormal fats in the blood) and thus are at risk for cardiovascular disease. Dyslipidemia may involve an elevation of total cholesterol, a reduction of low density lipoprotein (LDL) cholesterol and/or triglycerides , or a reduction of high density lipoprotein (HDL) cholesterol in blood. Statins work by blocking the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Cholesterol is described as a soft wax-like fatty substance that is found in the blood stream and in cells.

It is important to note that cholesterol is a naturally existing substance in all individuals from birth and its presence is actually necessary for promoting an overall healthy body. About 75% of cholesterol is produced by the liver and other cells in the body, and 25% comes from food. Cholesterol can have a negative impact on health, when there is too much bad LDL cholesterol circulating in the blood system. Contributing factors to high LDL levels may be unhealthy foods, genetics, lack of physical activity, and smoking . Triglycerides are a form of body fat that increases due to being overweight or obese , and physical inactivity, amongst others factors. High triglycerides levels may contribute towards heart disease and diabetes . HDL cholesterol is known as good cholesterol as it protects the heart against heart attacks: it is important to have an HDL level greater than 40 mg/dL. As previously mentioned, cholesterol contributes to cardiovascular disease as well as neurological and peripheral vascular disease . The way this occurs is by atherosclerosis, a condition, where over a course in time, cholesterol builds up in arteries and forms hardened plaques. If plaques rupture, blood clots may form on the plaque and block the arteries.

The clots also may dislodge and circulate within the body, block distant arteries, and ultimately reduce the flow of blood and oxygen through the arteries and to organs. Clots situated in the coronary arteries may give rise to angina or a heart attack . Clots in the carotid artery (the artery that supplies blood to the brain) may result in a stroke , and clots affecting the lower extremities such as the legs may result in peripheral arterial disease. Medically Reviewed by a Doctor on 4/29/2016 1 Cholesterol Medicines: What to Know The Newest Type of Drug: PCSK9 Inhibitors When you have high cholesterol, the first thing to do is to change your diet and fitness: less saturated fat, no trans fat, and more activity. If that doesn’t bring down your “bad” (LDL) cholesterol enough, your doctor may suggest that you also take medicine to help out. (You’ll still need to keep up those lifestyle habits.) There are several different types of prescription drugs that lower LDL. Get to know what each of them does. The Most Common Cholesterol Meds: Statins These are usually the first type of drug that doctors prescribe to lower LDL.

They also lower triglycerides, which are another type of blood fat, and mildly raise your "good" (HDL) cholesterol. Statins include: Rosuvastatin (Crestor) Simvastatin (Zocor) Studies show that statins lower the chance of a “cardiovascular event” such as a heart attack. Side effects can include intestinal problems, liver damage (rare), and muscle inflammation. High blood sugar and type 2 diabetes may also be more likely with statins, although the risk is “small” and the benefits outweigh the risks, according to the FDA. Statins drugs may also interact with other medications you take. Your doctor should check on that first. Some people who take statins have reported memory loss and confusion. The FDA is looking into those reports and notes that in general, the symptoms weren’t serious and were gone within a few weeks after the person stopped taking the drug. You should avoid grapefruit and grapefruit juice when you take statins. Grapefruit makes it harder for your body to use these medicines. Niacin What it is: This B-vitamin, also known as nicotinic acid, is found in food but is also available at high doses by prescription.

It lowers LDL cholesterol and raises HDL cholesterol. Examples include: Cholestyramine (Prevalite) Colesevelam (WelChol) A different type of drug, ezetimibe (Zetia), lowers bad LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have already had a heart attack, it can make a small cut in the risk of heart “events,” such as another heart attack, when you also take a statin. Side effects: For bile acid drugs, the most common side effects are constipation, gas, and upset stomach. For ezetimibe, the most common ones include muscle or back pain, diarrhea, and abdominal pain. Targeting Triglycerides: Fibrates “Fibrates” are drugs that cut down on how much triglycerides your body makes and can also boost your “good” HDL cholesterol. Examples include: Gemfibrozil (Lopid) The Newest Type of Drug: PCSK9 Inhibitors What they are: These drugs are used in people who can’t manage their cholesterol through lifestyle and statin treatments.

They block a protein called PCSK9 to make it easier for the body to remove LDL from your blood. They are mainly used in adults who inherit a genetic condition called “heterozygous familial hypercholesterolemia” that makes it hard to bring down their cholesterol level, or for people who had heart disease and need more than a statin. You get them as a shot every 2 weeks. Examples: Alirocumab (Praluent) Evolocumab (Repatha) Side effects: Because these drugs are newer, it will take more time to get to know their side effects. In clinical trials, the most common ones for alirocumab are itching, swelling, pain, or bruising where you get the shot, as well as colds and flu. For evolucumab, they include colds, flu, back pain, and skin reactions where you get the shot.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on March 22, 2016 Sources Statins Shown to Lower Blood Pressure Statins Shown to Lower Blood Pressure April 14, 2008 By Debra Kain A large, randomized drug trial has shown for the first time that statin drugs result in a modest, but significant, reduction in blood pressure. These effects may contribute to the reduced risk of stroke and cardiovascular events reported for patients on statins, according to lead investigator Beatrice Golomb, M.D., Ph.D., associate professor of medicine at the University of California, San Diego School of Medicine and director of UC San Diego’s Statin Study. The results of the double-blind, placebo-controlled study of 973 men and women in Southern California will be published in the April 14 edition of the journal Archives of Internal Medicine. “Statins, of course, are known to lower LDL cholesterol levels, but lower LDL cholesterol levels are not generally linked to lower occurrence of stroke,” said Golomb.

“However, lower blood pressure is strongly related to lower stroke risk, and these findings provide one means by which statins may reduce rates of stroke and other cardiovascular events in patients.” Study participants had no known cardiovascular disease or diabetes. Equal numbers of participants were either given 20 milligrams of simvastatin, 40 milligrams of pravastatin or a placebo daily for six months. Reductions in both systolic and diastolic blood pressure readings occurred in patients taking both simvastatin and pravastatin, two forms of statin drugs. “We found that statins lower both systolic and diastolic blood pressure, and that the effect extends to patients with pre-hypertension, those with normal blood pressure and persons not on blood-pressure lowering medications,” said Golomb. “While reductions in blood pressure with statins were measurable as early as one month into the trial, the lowered blood pressure was significant at six months.” Additional contributors to the study include Joel E. Dimsdale, M.D., UCSD Department of Psychiatry; Michael H. Criqui, M.D., MPH, UCSD Department of Family and Preventive Medicine; and Janis B. Ritchie, BSN, UCSD Department of Medicine.

Statins: Drug List, Names (Brand & Generic) & Side Effects Pharmacy Author: Omudhome Ogbru, PharmD Omudhome Ogbru, PharmD Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99. Medical and Pharmacy Editor: Jay W. Marks, MD Jay W. Marks, MD Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles. Medical Editor: Charles Patrick Davis, MD, PhD Charles Patrick Davis, MD, PhD Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ.

Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications. Are there differences among statins? What are statins, and how do they work? "Statins" is a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver . (The other source of cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG-CoA reductase inhibitors. Cholesterol is critical to the normal function of every cell in the body. However, it also contributes to the development of atherosclerosis , a condition in which cholesterol-containing plaques form within arteries. These plaques block the arteries and reduce the flow of blood to the tissues the arteries supply.

When plaques rupture, a blood clot forms on the plaque, thereby further blocking the artery and reducing the flow of blood. When blood flow is reduced sufficiently in the arteries that supply blood to the heart, the result is angina ( chest pain ) or a heart attack . If reduced flow is caused by plaques in the arteries of the brain, the result is a stroke . If reduced flow is caused by plaques in the arteries of the leg, they cause intermittent claudication (pain in the legs while walking ). By reducing the production of cholesterol, statins are able to slow the formation of new plaques and occasionally can reduce the size of plaques that already exist. In addition, through mechanisms that are not well understood, statins may also stabilize plaques and make them less prone to rupturing and develop clots. The important role of cholesterol in atherosclerosis is widely accepted by scientists. Research from the last few years shows that aggressive cholesterol reduction is more beneficial than modest reductions. Nevertheless, atherosclerosis is a complex process that involves more than just cholesterol. For example, scientists have discovered that inflammation in the walls of the arteries may be an important factor in in the development of atherosclerosis.

In addition to lowering cholesterol levels, statins also reduce inflammation, which could be another mechanism by which statins beneficially affect atherosclerosis. This reduction of inflammation does not depend on statins' ability to reduce cholesterol. Furthermore, these anti-inflammatory effects can be seen as early as two weeks after starting statins. What are some examples of statins? Statins that are approved for use in the U.S. include:

Question: Statins are drugs which lower what in the blood?
Answer: Cholesterol