Should I Take A Statin If My Cholesterol Is Normal
Yes, no, maybe. It depends on your other risk factors.
Some people still benefit from a statin even if their LDL is ânormal.â For example, you may want to consider statins if you have had a heart attack or you are at high risk for having another heart attack or even a stroke. Also, if you have diabetes and are between 45 and 75 years old, you are at high risk for cardiovascular disease.
In certain people, statins could also help to reduce the risk of heart disease and stroke, even if LDL cholesterol levels are low. For example, if you have high levels of inflammation in your arteries, statins can lower this inflammation and, in turn, lower the risk of cardiovascular disease. This is true even if your cholesterol levels are normal.
Help For Your Cholesterol When The Statins Won’t Do
If you are one of the many, but also one of the few…
After a routine check-up, your doctor says that you are one of the many, the 100 million Americans with an unhealthy cholesterol level. Since you are already pretty careful about your diet and you walk every day, medication is the next step. Like most physicians, your doctor prescribes one of the statin drugs. It’s a good choice these widely popular drugs can lower LDL cholesterol levels by 20%60%, thus reducing the risk of cardiac events by 24%37%. If that’s not enough reason to start therapy with a statin drug, consider that it appears to reduce the risk of stroke by 24%31% and it may even protect you against osteoporosis and dementia.
Table 1: Cholesterol goals for healthy adults
60 mg/dL or above
It’s a long list of side effects, but it shouldn’t stop doctors from turning to a statin first when medication is needed to bring cholesterol into range. Fortunately, most side effects are mild and disappear promptly when the statin is stopped. In some cases, the problems will resolve simply by reducing the dose or switching to another statin, but care is required. Still, all in all, the statins are the safest and best tolerated of all cholesterol-lowering medications.
Who Needs To Take Statins
In 2018, experts including the AHA and American College of Cardiology released guidelines recommending that doctors prescribe statins to people in the following four high-risk groups:
- People who have cardiovascular disease
- People with a high LDL cholesterol level
- People who are between 40 and 75 years of age and have type 2 diabetes
- People between 40 and 75 years of age who have at least a 7.5% risk of getting cardiovascular disease in the next 10 years
Statins may also be prescribed for people who have high cholesterol levels as a result of genetics. This inherited condition called familial hypercholesterolemia causes some people to produce too much LDL, or bad, cholesterol. Children with FH may also be prescribed statins.
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Effect Of Statin Therapy On Clinical Outcomes
A large number of studies using a variety of statins in diverse patient populations have shown that statin therapy reduces atherosclerotic cardiovascular disease. The Cholesterol Treatment Trialists have published meta-analyses derived from individual subject data. Their first publication included data from 14 trials with over 90,000 subjects . There was a 12% reduction in all-cause mortality in the statin treated subjects, which was mainly due to a 19% reduction in coronary heart disease deaths. Non-vascular causes of death were similar in the statin and placebo groups indicating that statin therapy and lowering LDL-C did not increase the risk of death from other causes such as cancer, respiratory disease, etc. Of particular note there was a 23% decrease in major coronary events per 1 mmol/L reduction in LDL-C. Decreases in other vascular outcomes including non-fatal MI, coronary heart disease death, vascular surgery, and stroke were also reduced by 20-25% per 1 mmol/L reduction in LDL-C. Additionally, analysis of these studies demonstrated that the greater the reduction in absolute LDL-C levels the greater the decrease in cardiovascular events. For example, while a 40mg/dl decrease in LDL-C will reduce coronary events by approximately 20%, an 80mg/dl decrease in LDL-C will reduce events by approximately 40%. These results support aggressive lipid lowering with statin therapy.
Check If You Can Take Statins
Statins are not suitable for everyone.
Check with your GP that it’s safe to take statins if you:
- have ever had an allergic reaction to statins or other medicines
- have liver or kidney problems
- have severe lung disease or difficulty breathing
- take medicine for bacterial or viral infections
- take medicines call fibrates
- are of Asian origin, such as Japanese, Chinese, Filipino, Vietnamese, Korean or Indian – your GP needs to choose the right start dose of Crestor to suit you
- over the age of 70 years
- drink large amounts of alcohol
- have an underactive thyroid
- have had muscular side effects when taking a statin in the past
- have had repeated or unexplained muscle aches or pains, or family history of muscle problems – including fibromyalgia
- are trying to get pregnant, pregnant, or breastfeeding
Atorvastatin is also not suitable if you’ve had a stroke, or have phenylketonuria.
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Statin Use During A Heart Attack
If youve had a heart attack or are dealing with any other type of acute coronary event, such as interventions like bypass surgery or angioplasty, chances are your physician will prescribe a statin during and immediately after the event, and for good reason. It is generally accepted in the medical community that statins may have some value independent of lowering LDL cholesterol, probably anti-inflammatory in nature.
But doctors do not have clear answers to the following: What statin is best? What dosage? How long should the patient be on it? Usually, high doses are prescribed immediately after the event and are then tapered to doses necessary to maintain target values .
There is much about statins we physicians do not know, states Dr. Ronald Scheib, MD, FACC, FACP, former Chief of Section of Cardiovascular Medicine at the Miami Heart Institute. We do know that toxicity is a clear danger.
When Should I See My Healthcare Provider
While youre taking statins, you should contact your provider if your muscles or joints hurt or if you feel weak, have a fever or your urine is dark.
A note from Cleveland Clinic
Statins can help you reduce your risk of a heart attack or stroke, but they arent a cure for high cholesterol. You should keep exercising and eating healthy even if youre taking statins. And have your cholesterol checked regularly so youll know if the statin is keeping it under control.
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Muscle Pain And Weakness
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 forum.ditonline.com contained more than 800 posts, many detailing severe side effects. The Lipitor board at www.rxlist.com 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.
Your Personal Risk Of Heart Attack Or Stroke
Remember: If your health care team suggests that you take a statin, its all to help lower the chances that you will have a heart attack or stroke caused by atherosclerotic cardiovascular disease .
ASCVD develops because of a buildup of sticky, cholesterol-rich plaque. Over time, this plaque can build up and narrow the arteries.
Your care team may have already talked with you about how a risk calculator can be used to find your risk of developing ASCVD or having a heart attack or stroke. This calculator factors in things like:
- Your age
- Systolic blood pressure
- If you smoke
- If you have diabetes
Your care team may also consider other factors that play a role or affect your risk. Because your risk can change over time, its important to keep talking with your care team about what steps you can take to stay healthy as you age.
Keep in mind that making lifestyle changes in addition to taking a statin or other medication can help protect your heart and improve your overall health.
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Why You May Want To Come Off Statins
Not everyone needs to stop taking statins. Many people take statins for decades without having any side effects or issues. For those individuals, the medications can be a very effective form of treatment and prevention for cholesterol problems.
Others may not have the same experience with statins. People who decide to quit taking statins may have several different reasons for doing so. The following are some of the most common reasons for quitting statins.
Putting Guidelines Into Practice
Will these guidelines change how your doctor checks and treats your cholesterol? Yes and no. Many physicians are already focusing on the balance of benefits and risks when making decisions about treatment. I, for one, am already prescribing statins to patients of mine at high risk of heart disease even when their cholesterol levels are close to normal. What will be new for me is making sure my patients are on an effective dose and no longer focusing on how low their LDL drops.
These new guidelines, while meant for doctors, contain a lot that each of us can do. Here are some examples.
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Who Should Not Take Statins
Before prescribing a statin to anyone with liver disease, a doctor should thoroughly discuss the risks and possible benefits. If the liver disease is stable and chronic, taking a low-dose statin may carry greater benefits than risks. If the liver disease is progressive, however, guidelines warn against using statins.
If liver disease develops while taking a statin, the persons doctor may recommend reducing the dosage of the statin, switching statins, or stopping their use.
People who are pregnant, breastfeeding, or intending to become pregnant should not take statins.
It is typically not safe to combine statins with:
- erythromycin, an antibiotic
- a person has peripheral arterial disease
- after a heart attack or stroke
- if a blood test gives an LDL cholesterol reading of 190 milligrams per deciliter or higher
- if the reading is 70 mg/dl or higher in people aged 4075 with diabetes
- if the reading is 70 mg/dl or higher in people aged 4075 with a high risk of developing heart disease or a stroke
Atherosclerosis can develop and form plaques even when blood cholesterol levels are low. Statins may benefit people who already have atherosclerosis or have a high risk of developing it, even if they do not have high cholesterol levels.
Mistake : Youre Not Exercising Enough
Diet alone is often not enough. It should be combined with exercise, says Michos. When it comes to exercise, the equation is pretty simple: Being sedentary equals lower levels of HDL, according to the AHA. You can lower both cholesterol and high blood pressure by doing at least 150 minutes of moderate-intensity exercise, such as walking, bicycling, swimming, or even doing yard work, each week.
Even more good news: A review published in November 2018 in the journal BioMed Research International found that both low- and moderate-intensity aerobic exercise led to a significant reduction in total cholesterol, including LDL.
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Lifestyle Therapy: The First Step
With so many people in need and so many medications available, it’s understandable that both doctors and their patients are tempted to rely on medications to improve unhealthy cholesterol levels. That’s a mistake. Instead, lifestyle therapy is the place to start. That means avoiding tobacco in all its forms. It also means choosing foods low in saturated fat, trans-fatty acids, and cholesterol while favoring foods that provide heart-healthy omega-3 and monounsaturated fats and large amounts of dietary fiber. It also requires regular exercise, which can be as simple as walking at a moderate pace for at least 30 minutes nearly every day. And the combination of a good diet and regular exercise should help men achieve another important goal, weight control.
Lifestyle therapy can improve cholesterol levels, and certain foods can provide extra help . But even with clean living, many people need medication to achieve optimal cholesterol levels, particularly when they have to reduce their LDL levels to 100 mg/dL or less. It’s important to keep up a good diet and exercise program even if you take medication. And if you can’t take a statin, here is a rundown of other medications that can help Table 3 summarizes their effects on blood lipids and compares them to the statins.
Isolated Hypercholesterolemia In Primary Prevention
In patients with isolated hypercholesterolemia without cardiovascular disease initial drug therapy is with a statin. The statin dose should be chosen based on the percent reduction in LDL-C required to lower the LDL-C level to below the target goal . As discussed earlier, the side effects of statin therapy increase with higher doses so one should not automatically start with high doses, but instead should choose a dose balancing the benefits and risks. Generic statins are inexpensive drugs and are very effective in both lowering LDL-C levels and reducing cardiovascular events. Additionally, they have an excellent safety profile. If the initial statin dose does not lower LCL-C sufficiently, one can then increase the dose. If the maximal statin dose does not lower LDL-C sufficiently adding ezetimibe is a reasonable next step if the LDL-C level is in a reasonable range and an additional 20-25% reduction in LDL will be sufficient. High dose statin and ezetimibe will lower LDL-C by as much as 70%, which will lower LDL-C to goal in the majority of patients who do not have a genetic basis for their elevated LDL-C levels. If the combination of statin plus ezetimibe does not lower the LDL-C to goal one can add a third drug, such as bempedoic acid or colesevelam. If the patient has diabetes with a moderately elevated A1c level using colesevelam instead of ezetimibe or in combination with ezetimibe could improve both glycemic control and further lower LDL-C levels.
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What Are The Side Effects Of Statins
Statins may cause mild side effects, including:
- Type 2 diabetes or high blood sugar.
Adults and teens can take statins. Most people dont have side effects from statins, but you shouldnt take them if youre pregnant, nursing or have certain types of liver disease. Let your provider know if you have diabetes. If youre already at risk for diabetes, statins can add to your risk of getting it.
Some people have an interaction with another medicine while taking statins. Whenever your provider considers prescribing medication for you, its important to tell them what else youre taking. That includes other prescription drugs, medicines you buy without a prescription, vitamins, herbs, supplements and recreational drugs.
If one type of statin gives you side effects, ask your provider if they can switch you to a different one. You may also want to ask your provider if you need to avoid grapefruit or pomegranate or their juices or if its ok to have a small amount. These foods can make it hard for your body to break some statins down, allowing too much of the drug to accumulate in your body and giving you more side effects.
What Is Rhabdomyolysis
Rhabdomyolysis initially causes muscle pain and can worsen to cause significant muscle breakdown or kidney failure. In rare cases, it can be fatal.
The condition is more common in people who take a statin in combination with another drug that carries rhabdomyolysis risk or raises the level of statin in the blood.
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How To Take And Store
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.