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.
Effect On Statins On Lipid And Lipoprotein Levels
The major effect of statins is lowering LDL-C levels. The effect of the various statins at different doses on LDL-C levels is shown in . As can be seen in different statins have varying abilities to lower LDL-C with maximal reductions of approximately 60% seen with rosuvastatin 40mg. Doubling the dose of a statin results in an approximate 6% further decrease in LDL-C levels. The percent reduction in LDL-C levels is similar in patients with high and low starting LDL-C levels but the absolute decrease is greater if the starting LDL-C is high. Because of this profound ability of statins to lower LDL-C levels, treatment with these drugs as monotherapy is often sufficient to lower LDL-C below target levels.
Effect Of Evinacumab On Clinical Outcomes
There are no cardiovascular outcome studies.
Homozygosity for loss-of-function mutations in ANGPTL3 is associated with significantly lower plasma levels of LDL-C, HDL-C, and triglycerides . Heterozygous carriers of loss-of-function mutations in ANGPTL3, which occur at a frequency of about 1:300, have significantly lower total cholesterol, LDL-C, and triglyceride levels than noncarriers . Moreover, patients carrying loss-of-function variants in ANGPTL3 have a significantly lower risk of coronary artery disease . Additionally, in an animal model of atherosclerosis treatment with evinacumab decreased atherosclerotic lesion area and necrotic content . Taken together these observations suggest that inhibiting ANGPTL3 with evinacumab will reduce cardiovascular disease.
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What Are Statin Medications
Statin medications are among the most commonly prescribed medications in the world. Although the medications belong to a class of prescription drugs called HMG CoA reductase inhibitors, they are more commonly referred to as statins due to the names of the medications. Statin medications are commonly used to lower levels of low-density lipoprotein, or LDL, cholesterol, which is the type of cholesterol that can cause damage to the blood vessels and cardiovascular system. Statin medications work by decreasing the amount of cholesterol produced by the liver. As a result of lower levels of cholesterol, the substance is less likely to cause the buildup of plaque along the walls of the blood vessels, which allows blood to flow freely from the heart to the brain, extremities, and organs.
Effect Of Bile Acid Sequestrants On Clinical Outcomes
The Lipid Research Clinics Coronary Primary Prevention Trial of cholestyramine vs. placebo was the first large drug study to explore the effect of specifically lowering LDL-C on cardiovascular outcomes . LRC-CPPT was a multicenter, randomized, double-blind study in 3,806 asymptomatic middle-aged men with primary hypercholesterolemia. The treatment group received cholestyramine 24 grams per day and the control group received a placebo for an average of 7.4 years. In the cholestyramine group total and LDL-C was decreased by 8.5% and 12.6% as compared to the placebo group. In the cholestyramine group there was a 19% reduction in risk of the primary end point accounted for by a 24% reduction in definite CHD death and a 19% reduction in nonfatal myocardial infarction. In addition, the incidence rates for new positive exercise tests, angina, and coronary bypass surgery were reduced by 25%, 20%, and 21%, respectively, in the cholestyramine group. The reduction in events correlated with the decrease in LDL-C levels . Of note, compliance with cholestyramine 24 grams per day was limited with many patients taking much less than the prescribed doses. These results indicate that lowering LDL-C with bile acid sequestrant monotherapy will reduce cardiovascular disease.
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Statins: Uses Side Effects And More
What are statins?
Statins are a group of medications used to treat high cholesterol. They work by decreasing the levels of cholesterol in your blood, especially low-density lipoprotein or bad cholesterol.
People with high LDL cholesterol are at an increased risk of developing cardiovascular disease. With this condition, cholesterol builds up in your arteries and can lead to angina, heart attack, or stroke. So, statins can be important in reducing these risks.
recommends statins for certain people. You and your doctor should consider statins if you:
Who Can Take Statins
You might be prescribed a statin if you have heart disease or another disease of the heart and blood vessels, or if you are at risk of developing them in the next 10 years.
If you have high cholesterol
You should be offered a statin if you have high cholesterol and lifestyle changes havent been enough to bring it under control.
Depending on your cholesterol levels and how healthy you are otherwise, you and your doctor or nurse might want you to try to bring your cholesterol levels down with a healthy diet and lifestyle first, before starting statins.
If you are at risk of developing heart disease
You will probably be prescribed a statin if you are at high risk of developing heart disease or a disease of the blood vessels. For example, if you have:
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Effects Of Statins On Hdl Cholesterol And Triglycerides
Although the main effects of statins are on lowering LDL cholesterol, there is a variable effect on HDL cholesterol and triglycerides. The magnitude of rise in HDL-cholesterol varies between the various statins. On the average it is about 10 %, but can reach up to 20 % or more. The effect is also dose dependent.
Triglyceride lowering by statins depends on basal triglyceride levels. With triglyceride levels between 200 and 400 mg/dL, triglyceride / LDL-C lowering ratio is 0.8. The ratio is 0.6 0.8 when the levels are between 150-200 mg/dL. The ratio becomes 0.3-0.4 when the triglyceride levels are below 150 mg/dL. The triglyceride lowering effects of statins are not optimal when triglyceride values are above 400 mg/dL.
Confusion Or Memory Problems
FDA , some people report having confusion or memory problems while taking a statin, although studies have shown conflicting results.
If you have these side effects, talk with your doctor. They may switch you to a different medication. These effects typically clear up within a few weeks after you stop taking the statin.
- alcohol use disorder
- conditions that affect the liver and kidneys
If you have one or more diabetes risk factors, you may be at increased risk of developing diabetes while taking statins.
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Mechanisms Accounting For Inclisiran Induced Lipid Effects
The mechanism of action of inclisiran is the same as for PCSK9 monoclonal antibodies . Briefly, decreasing the production of PCSK9 in the liver, the primary source of circulating PCSK9, leads to a decrease in plasma PCSK9 levels resulting in a decrease in in LDL receptor degradation . An increase in the number of hepatic LDL receptors increases the clearance of LDL leading to a decrease in LDL-C levels .
What Drugs Interact With Statins And Niacin
Statin drug interactions
Statins have some important drug interactions. The first type of interaction involves the enzymes responsible for the elimination of statins by the liver. Liver enzymes are responsible for eliminating all statins from the body with the exception of pravastatin and rosuvastatin.
Therefore, drugs that block the action of these liver enzymes increase the levels of simvastatin, lovastatin, fluvastatin, and atorvastatin in the blood and can lead to the development of rhabdomyolysis.
Drugs or agents that block these enzymes include:
Another important drug interaction occurs between statins and niacin and fibric acids, for example, gemfibrozil , clofibrate , and fenofibrate .
Niacin and the fibric acid drugs can cause rhabdomyolysis or liver failure when used alone, and combining them with statins increases the likelihood of rhabdomyolysis or liver failure. Gemfibrozil should not be combined with statins. Other fibric acids and niacin are used, with caution, in combination with statins.
Niacin drug interactions
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What Are Statins And How Do They Work
“Statins” is a class of drugs that lowers the level of low-density lipoprotein cholesterol in the blood by reducing the production of cholesterol by the liver.
How statins work
- Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase . Scientifically, statins are referred to as HMG-CoA reductase inhibitors.
What is cholesterol?
New Drug Reduces Bad Cholesterol And Triglycerides Without Statin Side Effects
Newswise A new drug, eprotirome, has been shown to significantly lower bad cholesterol, triglycerides and Lp, without the side effects that statins cause in many people. Results of a study were published today in the New England Journal of Medicine.
Our study has shown a dramatic reduction in the dangerous fats that cause heart disease, the number one killer of Americans, said Dr. John Baxter, director of the Genomic Medicine Program at The Methodist Hospital Research Institute and co-author for the study.
For patients taking a statin, this drug can further lower LDL cholesterol by 25 percent on top of what the statin is doing. It is also as potent in lowering triglycerides as any current medication available today, Baxter added. It also lowers Lp, which is an under recognized factor that also causes atherosclerosis and is a common cause of heart attack in young people. Thus, eprotirome could be a major complement to the only current medication for this condition, niacin, which causes flushing side effects.
While statins remain the gold standard for cholesterol reduction today, they are still limited in helping patients reach strident goals set to reduce a patients risk for heart disease and heart attack, and they can have significant side effects, Baxter added.
The frequency, pattern and intensity of adverse events were similar in placebo and eprotirome-treated patients.
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Are Statins Really Worth Taking For High Cholesterol
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Research has shown that statins are highly effective in reducing the risk of fatal heart attack and stroke. But some people are reluctant to take these life-saving drugs. They worry about taking medicine every day for the rest of their life or have heard that statins have undesirable side effects. What does science have to say about these concerns and others surrounding statins? We talked to UH interventional cardiologist Ian Neeland, MD, Director of the Center of Cardiovascular Prevention at University Hospitals, to learn more.
Side Effects Of Statin Medications
In most cases, statin medications can be safely taken to help decrease the production of harmful cholesterol in the body. Side effects are typically minor and commonly include diarrhea, forgetfulness, headache, heartburn and joint pain.
Muscle aches are the most common side effect and may diminish over time. In cases where they dont go away, your doctor may switch you to a different type of statin medication. Severe muscle pain should be discussed with your health care provider right away since it can be a sign of rhabdomyolysis, which destroys muscle cells.
Rarely, liver damage or liver failure can occur. Because of this, statin medications are not recommended for people with liver disease. Liver enzymes should be checked prior to beginning statin therapy and as your provider recommends afterward.
Statin-related memory issues, including memory loss, forgetfulness, confusion and amnesia, have been reported in rare instances. In most cases, these symptoms are mild and cease after you stop taking the medication.
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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 .
Whos More Likely To Have Side Effects From Statins
Not everyone who takes a statin has side effects. According to a , youre more likely to experience side effects if you:
- were assigned female at birth
- are 65 years old or older
- have type 1 or 2 diabetes
- take multiple medications to lower your cholesterol
- have a smaller body frame
- have liver or kidney disease
- consume too much alcohol
If youre experiencing side effects, a doctor or other healthcare professional may want you to try another statin, change your dosage, or try a different medication.
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Can Statins Damage My Liver
Liver damage from taking statins is extremely uncommon. We used to test patients for liver damage throughout the course of statin treatment, but because of the rarity of that potential side effect, the Food and Drug Administration determined that regular monitoring of liver function tests is unnecessary for patients taking statins. Now, we check a patients liver enzymes before we begin statin therapy to ensure the liver is healthy before treatment begins, and we dont put anyone through unnecessary testing during treatment, unless symptoms arise.
Interestingly, there is a statin study examining people who already had abnormal liver function tests and fatty liver. Roughly half of the participants took a statin medication, and the other half took a placebo. The people who took statins actually had improvements in their liver function compared to the placebo group and had a lower risk of cardiovascular events. People who have blood sugar issues, have insulin resistance, and are obese or have other risks for heart disease often have fatty liver and abnormal liver function tests. The study suggests that these people may need statins the most.
Can Natural Remedies Lower High Cholesterol Without Statins
Exercise on its own doesnt lower your LDL much often only a few points. Exercise helps minimize many heart disease risk factors, including obesity and Type 2 diabetes. Make a point to exercise five days a week for at least 30 minutes each day.
Diet is incredibly important in managing your cholesterol.Every patient who comes to our preventive cardiology clinic for cholesterol management sees a nutritionist as part of the visit because we feel so strongly about the importance of diet. There are many patients for whom weve delayed prescribing statins, or suggested that they get off their medication if it isnt appropriate for their level of risk.
Some patients think, Im on a statin I dont have to exercise, and I can eat whatever I want! But thats not the case. Lifestyle choices absolutely matter. For high-risk patients, its not a question of either improving the diet or getting on a medication, its both lifestyle changes and taking a statin together are necessary to protect high-risk patients against heart attack and stroke.
If your cholesterol is borderline but not yet high, changing your diet and incorporating healthier food choices can help lower your cholesterol a decent amount. Eating more fiber and lowering your intake of saturated fat definitely can help. For people with relatively low risk, this may be enough to lower heart attack and stroke risk.
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Effect Of Pcsk Inhibitors On Lipid And Lipoprotein Levels
There are a large number of studies that have examined the effect of PCSK9 inhibitors on lipid and lipoprotein levels. A meta-analysis of 24 studies comprising 10,159 patients reported a reduction in LDL-C levels of approximately 50% and in an increase in HDL of 5-8% . Notably, in 12 RCTs with 6,566 patients, Lp levels were reduced by 25-30% . The higher the baseline Lp the greater the reduction with treatment . It should be recognized that most LDL-C lowering drugs do not lower Lp levels. PCSK9 inhibitors have not been shown to decrease hs-CRP levels .
MONOTHERAPY
Both alirocumab and evolocumab have been studied as monotherapy vs. ezetimibe. In the Mendel-2 study patients were randomly assigned to evolocumab, placebo, or ezetimibe . In the evolocumab group, LDL-C levels decreased by 57% while in the ezetimibe group LDL-C levels decreased by 18% compared to placebo. Additionally, non-HDL-C was decreased by 49%, apolipoprotein B by 47%, triglycerides by 5.3% , and Lp by 18.5% while HDL levels increased by 5.5% in the evolocumab treated subjects. In a study of alirocumab vs. ezetimibe, LDL-C levels were reduced by 47% in the alirocumab group and 16% in the ezetimibe group . In addition, alirocumab decreased non-HDL-C by 41%, apolipoprotein B by 37%, triglycerides by 12%, and Lp by 17% and increased HDL by 6%. Thus, PCSK9 monoclonal antibodies are very effective in lowering pro-atherogenic lipoproteins when used in monotherapy and have a more robust effect than ezetimibe.