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.
Mechanism Accounting For The Mipomersen Induced Lipid Effects
Apolipoprotein B 100 is the main structural protein of VLDL and LDL and is required for the formation of VLDL and LDL . Familiar Hypobetalipoproteinemia is a genetic disorder due to a mutation of one apolipoprotein B allele that is characterized by very low concentrations of LDL and apolipoprotein B due to the decreased production of lipoproteins by the liver . Mipomersen, an apolipoprotein B antisense oligonucleotide, mimics Familiar Hypobetalipoproteinemia by inhibiting apolipoprotein B 100 production in the liver by pairing with apolipoprotein B mRNA preventing its translation . This decrease in apolipoprotein B synthesis results in a decrease in hepatic VLDL production leading to a decrease in LDL levels.
What Special Dietary Instructions Should I Follow
Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program website for additional dietary information at .
Avoid drinking large amounts of grapefruit juice while taking atorvastatin.
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How Effective Is Zetia In Lowering Cholesterol
In a clinical study comparing Zetia to a placebo, Zetia was effective in decreasing cholesterol absorption from the small intestine by 54%.
Zetia can be taken as a sole cholesterol lowering medication, or Zetia can be prescribed together with other cholesterol lowering medications including statins or fenofibrate. These additional cholesterol lowering drugs have a complementary lipid lowering effect, as they work in a different way to Zetia to reduce cholesterol levels.
Zetia should be taken in conjunction with lifestyle changes including cholesterol lowering diet, exercise and a weight management plan.
Causes And Risks Factors
Many factors influence your cholesterol levels. Lifestyle choices can have a big impact on your dietary cholesterol levels and your bodys ability to effectively remove cholesterol from the blood. A diet that is rich in high-fat foods and animal products such as red meats, eggs and butter, and lower in fruits, vegetables, and whole grains has been linked to higher cholesterol levels.
In addition, a sedentary lifestyle can increase your risk. Smoking cigarettes or using vaping products can also directly raise cholesterol levels.
Cholesterol levels can also be partially determined by your genetics. Some people have genetic disorders, such as a condition called familial hypercholesterolemia , that can lead to high levels of LDL cholesterol in their blood.
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Statin Use Among Children
Several statins are approved by the FDA for use in children. Some are approved for children over 8 years of age and others for children at least 10 years of age. Approved statins include: atorvastatin , fluvastatin , lovastatin , pravastatin , rosuvastatin , and simvastatin .
Statins are usually used to treat children with genetic conditions that cause hyperlipidemia, which is an excess of lipids like cholesterol and triglycerides in the blood. Short term studies in children show some improvement in measures like LDL cholesterol, blood flow, and thickness of the artery walls. However, statin research has not studied children for more than 2 years, so we dont know the long-term risks of statins for children, or if treatment in childhood actually improves health over a longer period of time or into adulthood. We also dont know which of the statins work better in children.
Written By Michael Greger M.D. FACLM on November 8, 2016
For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients dont want to take drugs unless they have at least a one in five chanceeven those who just had a heart attack. Its no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.
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.
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Once I Start Using Statins Will I Be On Them Forever
Yes, most people will need to keep taking their statin. The benefits of reducing your risk of having a stroke or heart attack will only continue for as long as you take it. If you stop taking the statin without starting a different cholesterol-lowering treatment, your cholesterol level may rise again.
Serious Side Effects Of Statins
Statins are linked to a few rare but potentially serious side effects, including:
- Myositis, which is inflammation of the muscles. The risk of muscle injury increases when certain other medications are taken with statins. For example, if you take a combination of a statin and a fibrate — another cholesterol-reducing drug — the risk of muscle damage increases greatly compared to someone who takes a statin alone.
- Elevated levels of CPK, or creatine kinase, a muscle enzyme that when elevated, can cause muscle pain, mild inflammation, and muscle weakness. This condition, though uncommon, can take a long time to resolve.
- Rhabdomyolysis, extreme muscle inflammation and damage. With this condition, muscles all over the body become painful and weak. The severely damaged muscles release proteins into the blood that collect in the kidneys. The kidneys can become damaged trying to eliminate a large amount of muscle breakdown caused by statin use. This can ultimately lead to kidney failure or even death. Fortunately, rhabdomyolysis is extremely rare. It happens in less than one in 10,000 people taking statins.
If you have any unexplained joint or muscle pain, tenderness, or weakness while taking statins, you should call your doctor immediately.
Some studies link statin use with birth defects. Doctors advise pregnant women not to use these drugs.
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Effect Of Bempedoic Acid On Clinical Outcomes
Currently there are no outcome studies determining the effect of bempedoic acid on atherosclerotic cardiovascular disease. The effect of bempedoic acid on cardiovascular disease is currently being evaluated in a large ~3.5-year clinical trial . In animal models of atherosclerosis, treatment with bempedoic acid had favorable effects on atherosclerosis . Moreover, genetic variants that mimic the effect of ATP citrate lyase inhibitors lower LDL-C levels and are associated with a decrease in cardiovascular disease suggesting that bempedoic acid will have favorable effects on reducing the risk of cardiovascular disease .
Truths About Statins And High Cholesterol
For every drop of scientific evidence that statins are safe and effective, there is a tidal wave of misinformation. Our patients are concerned about statin side effects theyve heard about from family or friends, or read about on the Internet.
Statins are the gold-standard for high cholesterol treatment. Theyre a powerful medication, and theyve been proven to save the lives of many men and women living with or having a high risk of heart attack or stroke.
But if statins are so effective, why are some people afraid to take them?
As with any medication, there are risks associated with taking statins, but the benefits far outweigh the risks for the vast majority of high-risk patients.
In an effort to put statin side effects into context and provide honest, scientific answers about statins and their use, weve put together a list of common questions our patients ask us:
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Why Have I Been Offered Statins
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries and cardiovascular disease .
CVD is a general term that describes a disease of the heart or blood vessels. It’s the most common cause of death in the UK.
The main types of CVD are:
- coronary heart disease when the blood supply to the heart becomes restricted
- angina chest pain caused by reduced blood flow to the heart muscles
- heart attacks when the supply of blood to the heart is suddenly blocked
- stroke when the supply of blood to the brain becomes blocked
A doctor may recommend taking statins if either:
- you have been diagnosed with a form of CVD
- your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk
Find out more about when statins may be recommended.
*Patient Eligibility for Savings Card:
You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.
Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs , Department of Defense programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured patient.
This offer is not insurance and is restricted to residents of the United States and Puerto Rico, and patients over 18 years of age. This offer is valid for retail prescriptions only.
Program managed by ConnectiveRx, on behalf of AstraZeneca.
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How Should This Medicine Be Used
Atorvastatin comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take atorvastatin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atorvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may start you on a low dose of atorvastatin and gradually increase your dose, not more than once every 2 to 4 weeks.
Continue to take atorvastatin even if you feel well. Do not stop taking atorvastatin without talking to your doctor.
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?
Its 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.
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Bile Acid Binding Resins
For example, the FDA has approved a class of drugs known as bile acid binding resins, which were the first cholesterol drugs before statins. Studies in the 1980s showed that these medications lower heart disease risk. One reason they arent often prescribed is that patients have to take a lot of them compared to statins. Bile acid binding resins come in powder form or require taking up to six pills a day. Also, they can cause gastrointestinal side effects.
Weve known since the 1990s that statins benefit patients at high risk for stroke and heart disease. Today, several investigators are researching which complementary medications can be prescribed on top of statins to make them even more beneficial and protective.
One of these is a drug called Ezetimibe, which on its own provides a modest reduction in cholesterol. Its also been shown recently to lower heart attack and stroke risk when taken in addition to a statin.
Who Can And Cannot Take Ezetimibe
Ezetimibe can be taken by adults and children from the age of 10 years.
Ezetimibe is not suitable for some people. To make sure it is safe for you, tell your doctor if you:
- have had an allergic reaction to ezetimibe or any other medicines in the past
- have liver problems
- are pregnant, planning to become pregnant or are breastfeeding
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Who Should Take A Statin
Your doctor will advise if you should take a statin. A statin is usually advised if:
- You have a high cholesterol level .
- You have an atheroma-related disease. This is a cardiovascular disease such as angina or peripheral arterial disease, or you have had a heart attack , stroke or transient ischaemic attack . A statin helps to reduce the risk of these conditions getting worse or, it can delay the disease becoming worse.
- You have a high increased risk of developing an atheroma-related disease. For example, if you have diabetes, or other risk factors. Risk is measured as a percentage. Risk is considered to be high when your score is 10% or more . See the separate leaflet called Cardiovascular Health Risk Assessment.
Note: a statin is just one factor in reducing your risk of developing cardiovascular diseases. See the separate leaflet called Cardiovascular Disease .
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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My Doctor Put Me On A Statin So Im Fine Right
A statin is a type of drug that works to lower your cholesterol by restricting the enzyme involved in your own bodys cholesterol production.
As with any medication, statins do come with some side effects. The most common symptom, is muscle aches/pain, occurring in about 5 percent of people on a statin . Other less common side effects include increased blood sugar, inflammation in the liver, and confusion . Unfortunately, statins are also known for decreasing the levels of coenzyme q10 in the body, which is involved in many nerve and muscle pathways .
Statins can improve some cholesterol numbers and may reduce the risk of a heart attack . Doctors may recommend a statin to you for reasons like family history/risk, for example. For most of us, though, statins do not address the most common root causean unhealthy lifestyle! Improving diet, exercise, and stress may reduce your risk of heart attack by up to 80 percent !
My point in saying this isnt for you to go willy nilly and nix your statins. Instead, it is SO IMPORTANT to understand that we cannot take a drug and call it good. We have to make lifestyle modifications our primary focus in order to make REAL change in our health!
The most powerful medication you can take is at the end of your fork.
Disclaimer: Please talk to your doctor before starting or stopping any medication.