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How Do Statin Drugs Work To Lower Cholesterol

How To Take And Store

How Statins Work to Reduce Cholesterol

Lipitor can be taken with or without food. It is quickly absorbed, reaching its peak concentration in the blood within about two hours. Lipitor starts to lower cholesterol within about two weeks of starting the medication.

Lipitor should always be taken in conjunction with a diet to lower your cholesterol and triglycerides.

Store the tablets at a controlled room temperature that’s ideally 68 to 77 degrees F.

If you miss a dose of Lipitor, take it as soon as you remember. But if it has been more than 12 hours since the missed dose, skip it and just take your next scheduled dose. Do not take two doses at once.

If you take too much Lipitor or overdose, seek immediate medical care.

The Scoop On Statins: What Do You Need To Know

Why is it important to understand the benefits and risks of statins?

Most heart attacks and strokes are preventable by practicing a healthy lifestyle, and when necessary, taking medications to lower blood pressure or cholesterol or to help quit smoking. Statins, when used as indicated, can dramatically reduce a persons risk of having a heart attack or stroke, but millions of people are missing that opportunity. Some clinicians may miss prescribing a statin to a person who can benefit. Many times, individuals stop or do not start taking a statin due to concerns about side effects. The good news is that understanding your individual benefits and risks and working through your concerns with your clinician can help you prevent heart attacks and strokes and enjoy a longer, healthier life.

What is a statin and how does it work?

Statins are a class of medicines used to lower cholesterol. While some of the cholesterol in your blood comes from food, most is made by the liver. Statins work by reducing the amount of cholesterol made by the liver and helping the liver remove cholesterol that is already in the blood. Statins may also reduce inflammation in the artery walls. This can lead to blockages that damage organs such as the heart and brain.

What are the benefits of statins?

What are the risks of a statin?

How can side effects be managed when taking a statin?

Who should consider taking a statin?

What should I ask my clinician?

Where can I learn more?

Who Should Be Treated

In a sense, everyone. Thats because no cholesterol level is too good. But people with unhealthy levels should work hard to improve, while those with ideal results can afford to relax a bit. Table 1 shows the goals established by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

Cholesterol is a crucial determinant of cardiovascular health, but its only one. In fact, smoking is even more dangerous than unhealthy cholesterol levels, and high blood pressure, diabetes, and lack of exercise are nearly as harmful. Because each risk factor adds to the harm of others, people with the most risk need the most vigorous treatment. Table 2 shows how an individuals risk profile influences the choice of therapy.

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Effect On Evinacumab On Lipid And Lipoprotein Levels


A double-blind, placebo-controlled trial randomly treated patients with Homozygous Familial Hypercholesterolemia with an intravenous infusion of evinacumab 15 mg/Kg every 4 weeks or placebo . The individuals in this trial were on lipid lowering therapy and the mean baseline LDL-C level was approximately 250-260mg/dL. After 24 weeks of treatment patients in the evinacumab group had a 47% reduction in LDL-C levels vs. a 1.9% increase in the placebo group . This decrease in LDL-C levels was observed after 2 weeks of therapy and was observed regardless of concomitant use of other lipid lowering drugs or apheresis. Notably, in individuals with null-null LDL receptor variants evinacumab resulted in a 43% decrease in LDL-C levels indicating that evinacumab therapy was effective in the absence of functional LDL receptors. As expected, total cholesterol, non-HDL-C cholesterol, and apo B levels were also decreased. Moreover, triglyceride levels decreased 55% and HDL-C levels decreased 30% with evinacumab administration while Lp levels were unchanged.

What Should I Consider When Deciding If I Should Start Treatment With A Statin

Statins and the Prevention of Heart Disease.

The balance of benefit and risk will differ for each person.

  • For example, people at the highest cardiovascular risk will benefit the most from taking a statin. Any possible side effects from statins are likely to be thought of as a lower risk.
  • On the other hand, people at a lower level of cardivascular disease risk will have less benefit from taking a statin but have the same risk of side effects. Therefore they may feel that the risk of taking a statin outweighs the benefit.

Your doctor will discuss your cardiovascular risk with you, any possible side effects and how these could affect you.

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Effect Of Bile Acid Sequestrants On Lipid And Lipoprotein Levels

The major effect of bile acid sequestrants is to lower LDL-C levels in a dose dependent fashion. Depending upon the specific drug and dose the decrease in LDL-C ranges from approximately 5 to 30% . The effect of monotherapy with bile acid sequestrants on LDL-C levels observed in various studies is shown in .

Side Effects Of Statins

Many people who take statins experience no or very few side effects.

Others experience some troublesome, but usually minor, side effects, such as diarrhoea, a headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if theyre offered to you.

The risks of any side effects also have to be balanced against the benefits of preventing serious problems.

A review of scientific studies into the effectiveness of statins found around 1 in every 50 people who take the medicine for 5 years will avoid a serious event, such as a heart attack or stroke, as a result.

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Can Statins Increase My Risk For Memory Loss Or Dementia

Memory and cognitive symptoms from statin use are very uncommon, and it is unclear if statins are really the culprit. When symptoms have been reported, theyre typically not severe and usually resolve when the statin dosage is adjusted or the medication is switched.Affected patients have reported feeling unfocused or fuzzy in their thinking, but these experiences are rare. Concerns about long-term cognitive problems and memory loss due to use of statins have not been proven. On the contrary, most recent data actually point to potential prevention of dementia due to statin use.These data are logical because one of the major causes of dementia is atherosclerosis, which is hardening of the arteries in the brain. There is strong evidence that statins protect against atherosclerosis. Its one of the invisible benefits of taking a statin medication.Also, keep in mind that increasingly high cholesterol and memory problems both are common symptoms of aging. Sometimes its difficult to disentangle these two, and thats why statin use and memory problems may seem related at times.If youre concerned about statins and memory loss, dont stop taking your medication without consulting your doctor. There may be other reasons for your memory symptoms, or alternate treatments for your high cholesterol can be considered.

Myth #: Statins Frequently Cause Memory Loss

How do statins prevent heart attacks and strokes?

Truth: In 2012, the FDA changed statin drug labels to include information that some people had experienced memory loss and confusion while taking the medications.

Unfortunately, that change was based on some poor-quality studies and evidence, Martin explains. People became seriously concerned that lower cholesterol levels could affect the brains function. But in fact, the brain makes its own cholesterol. It doesnt depend on the cholesterol in the blood.

My colleagues and I at Johns Hopkins specifically researched the issue of statins impacting cognitive dysfunction or dementia, says Martin. We reviewed all the studies that had been done, and found that the most rigorous studies show that statins do not commonly cause memory loss. If anything, long-term use of statins might have a beneficial effect on the brain since they help prevent strokes and protect the health of arteries in the brain.

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Eating Healthy But Your Ldl Is Still High

If you have transitioned to a whole food, plant-based diet and still have high LDL, you may want to take a closer look at your family history, diet, and lifestyle.

Most cases of high cholesterol are not caused by a single inherited condition but result from a combination of lifestyle choices and the effects of variations in many genes. Familial hypercholesterolemia occurs because of a genetic defect on chromosome 19. Its an inherited disorder that makes it harder for your body to remove LDL cholesterol from your blood. However, your genes are not your destiny, and the first line of treatment for FH is lifestyle modification.

Lower Your Fat Intake


Being physically active is another way to maintain healthy cholesterol levels, particularly for strength training, aerobics, and high-intensity exercise such as HIIT . However, even low-intensity exercise has been shown to increase HDLs anti-inflammatory and antioxidant capabilities. Exercise can also help to lower LDL cholesterol when combined with dietary changes and weight loss.

Diet or Statins?

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How Fast Do Statins Work

Many doctors are prescribing statins to lower cholesterol in their patients. High cholesterol is one of the many risk factors that are associated with heart disease. Statins generally act quickly to reduce cholesterol but results vary from patient to patient.


  • Introduced to the market in 1987, statins have become one of the most widely used medications to treat high cholesterol and controlling cholesterol is one main way to prevent heart disease.

How Statins Work

  • In many patients, healthy diets and exercise is not enough to lower cholesterol. These patients may be put on statin therapy. Statins work by reducing the formation of artery-clogging plaque. They often reduce LDL or bad cholesterol by up to 50% and increase a patients HDL or good cholesterol by up to 15%.

Maximizing Statin Results

  • The effectiveness of statins can be affected by patient lifestyle. Patients who make healthy lifestyle modifications can often see a reduction in their cholesterol as early as two weeks after starting statin therapy. A diet that is low in saturated fats and cholesterol slows down the formation of fatty plaque more quickly than a patient who continues a diet high in fats.

Statins and Heart Disease

  • In combination with a healthy lifestyle, statins lower cholesterol levels and also reduce the risk of heart attack, stroke and other cardiovascular events.

Full Effects

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How And When To Take Statins

Always take statins exactly as your GP or pharmacist has told you. Check with your GP or pharmacist if you are not sure.

Usually, statins should be taken once a day.

Simvastatin, pravastatin and fluvastatin should be taken at night. This is because most of the cholesterol your body produces is during the night time.

Atorvastatin or rosuvastatin can be taken at any time, as long as you stick to the same time every day.

Statins do not usually upset the stomach. You can take them with or without food.

Swallow statin tablets whole with a glass of water.

Statins And Grapefruit Juice

Reduce Cholesterol Naturally using Plant Sterols and Stanols ...

Grapefruit juice increases blood levels of atorvastatin, lovastatin, and simvastatin, which actually increases the effectiveness of these drugs, but may also increase the risk of side effects, although the actual increased risk of rhabdomyolysis is minimal. The manufacturers advice is to avoid drinking grapefruit juice while taking these statins.

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Is There Any Difference Between The Different Statins

There are a few statins available in New Zealand atorvastatin , pravastatin , rosuvastatin and simvastatin . Rosuvastatin is not subsidized you will need to pay for the cost of this medicine in full. In New Zealand, atorvastatin is the preferred statin and is most widely used. If you have side effects with atorvastatin, your doctor may consider lowering the dose or changing to another statin.

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How Will My Doctor Know I Am At High Risk Of Heart Disease

By doing a cardiovascular or heart risk assessment your GP will build up a picture of your risk profile. This involves examining your family health history, age, weight and smoking history and diabetes status, and then testing indicators including your cholesterol levels and blood pressure. Your GP may use a computerised tool called Predict to calculate your risk. This will give you a percentage risk of developing vascular disease and can even track your potential progress as you age.

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Get Relief From Statin Side Effects

Your doctor may be able to suggest some ways to relieve the side effects you have with statins. These changes may help, but talk to your doctor first:

  • Take a break from statins, which can help you know if the drugs are the cause of muscle aches or other side effects
  • Try a different statin drug or dose
  • Change your exercise routine gradually and skip intense workouts if youâre not used to them
  • Try another type of medication to lower your cholesterol
  • Take coenzyme Q10 supplements, which may stave off side effects in some people

The statin medications that are approved for use in the U.S. include:

  • Lipitor

Muscle Pain And Weakness

How Statins Work

The most common side effect is muscle pain and weakness, a condition called rhabdomyolysis, most likely due to the depletion of Co-Q10, a nutrient that supports muscle function. Dr. Beatrice Golomb of San Diego, California is currently conducting a series of studies on statin side effects. The industry insists that only 2-3 percent of patients get muscle aches and cramps but in one study, Golomb found that 98 percent of patients taking Lipitor and one-third of the patients taking Mevachor suffered from muscle problems.4 A message board devoted to Lipitor at contained more than 800 posts, many detailing severe side effects. The Lipitor board at contains more than 2,600 posts .

The test for muscle wasting or rhabdomyolysis is elevated levels of a chemical called creatine kinase . But many people experience pain and fatigue even though they have normal CK levels.5

John Altrocchi took Mevacor for three years without side effects then he developed calf pain so severe he could hardly walk. He also experienced episodes of temporary memory loss.

Active people are much more likely to develop problems from statin use than those who are sedentary. In a study carried out in Austria, only six out of 22 athletes with familial hypercholesterolemia were able to endure statin treatment.9 The others discontinued treatment because of muscle pain.

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Mechanisms Accounting For Bile Acid Sequestrants Induced Lipid Effects

Bile acid sequestrants bind bile acids in the intestine, preventing their reabsorption in the terminal ileum leading to the increased fecal excretion of bile acids . This decrease in bile acid reabsorption reduces the size of the bile acid pool, which stimulates the conversion of cholesterol into bile acids in the liver . This increase in bile acid synthesis decreases hepatic cholesterol levels leading to the activation of SREBPs that up-regulate the expression of the enzymes required for the synthesis of cholesterol and the expression of LDL receptors . The increase in hepatic LDL receptors results in the increased clearance of LDL from the circulation leading to a decrease in serum LDL-C levels . Thus, similar to statins and ezetimibe, bile acids lower plasma LDL-C levels by decreasing hepatic cholesterol levels, which stimulates LDL receptor production and thereby accelerates the clearance of LDL from the blood.

The mechanism by which treatment with bile acid sequestrants improves glycemic control is unclear .

Weighing The Risks And Benefits Of Statins

When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

  • Do I have other risk factors for heart and blood vessel disease?
  • Am I willing and able to make lifestyle changes to improve my health?
  • Am I concerned about taking a pill every day, perhaps for the rest of my life?
  • Am I concerned about statins’ side effects or interactions with other drugs?

It’s important to consider your medical reasons, personal values, lifestyle choices and any concerns when choosing a treatment. Talk to your doctor about your total risk of heart and blood vessel disease and personal preferences before making a decision about statin therapy.

© 1998-2022 Mayo Foundation for Medical Education and Research . All rights reserved. Terms of use.

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Common Side Effects Of Statins

The most commonly reported side effects of statins include:

  • a headache
  • heartburn, indigestion, nausea, or stomach discomfort
  • lower back or side pain, tenderness around the eyes or cheekbones
  • nasal congestion or stuffiness, or a runny nose
  • slight muscle pain
  • sweating.

Other side effects, such as liver damage, are rare, and it is not necessary to have ongoing liver tests while you are taking a statin once you have had a baseline liver function test done.

What Are Some Possible Side Effects Of Pcsk9 Inhibitors

Lower Your Cholesterol the Healthy Way

Possible side effects include pain, including muscle pain and back pain, or swelling at the injection site and cold-like symptoms. Another drawback may be cost as these products may be expensive.

Fibric acid derivatives

Fibric acid derivatives make up another class of drugs that reduce blood lipid levels, especially triglycerides. Triglycerides are fats that come from food that are created when you consume calories that are not spent.

Fibric acid derivatives may also increase the level of HDL, also called the good cholesterol, while lowering liver production of LDL, the bad cholesterol. People who have severe kidney disease or liver disease should not take fibrates.

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