Tell Me About… How Statins Work To Lower Cholesterol

Tell Me About… How Statins Work To Lower Cholesterol - There are a lot of articles on Facebook about the dangers of statins. I don’t know what to believe anymore. On the one hand, my doctor is telling me that my blood cholesterol is high, and I must be on statins as they will lower it. On the other hand, my non-doctor friends tell me statins are dangerous. What are statins anyway?

Statins are a type of drug that can lower your cholesterol. They are also called HMG-CoA Reductase Inhibitors in the pharmacological world. They function by blocking a substance (HMG-CoA Reductase) that your body needs to make cholesterol. Hence, your blood cholesterol will be lowered. 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 that can lead to heart attacks.

Should everyone with high blood cholesterol be on statins then?

There are guidelines to follow before a doctor puts someone on statins. Generally, the guidelines recommend that you try diet and physical exercise to get your cholesterol down before going on statins. Then after you have tried your best, statins or other lipid-lowering agents can be recommended. Statins can be used for two purposes (here, the prevention refers to preventing heart disease):

Primary Prevention:

If you have at least one risk factor for heart disease (high blood cholesterol, diabetes, high blood pressure, smoking), are between the ages of 40 and 75, and have at least a 10% risk of heart disease as assessed by the ACC/AHA Pooled Cohort equation – then you should be on statins. If you are not sure how to assess this on your own, visit a cardiologist. Even general practitioners might not be able to assess this as well as a cardiologist. Generally, if you have very high blood cholesterol, even without other risk factors, the doctor will also put you on statins.

Secondary Prevention:

If you already have pre-existing cardiovascular disease such as a previous heart attack, stable angina (chest pain during effort) and unstable angina, then statins are effective in preventing further deterioration or lessening the risk of more attacks. Most people aim to keep their total cholesterol level below 200 milligrams per deciliter (mg/dL) or 6.22 millimoles per liter (mmol/L). Low-density lipoprotein cholesterol (LDL, or “bad” cholesterol) should be below 100 mg/dL (3.37 mmol/L).

How much cholesterol can a statin lower?

There are different types of statins that have been formulated throughout history. Some claim to be more powerful than others. On the average, statins lower LDL by 1.8 mmol/L. This leads to around 60% lowering in the number of heart attacks and deaths due to heart attacks, and also a 17% reduction in stroke after you take it for a long time. They can also raise your HDL cholesterol (high density lipoprotein or “good” cholesterol), which helps protect your arteries and heart disease. But they do this less effectively than some other agents like fibrates and niacin.

What types of statins are there?

Statins include atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), and many generic versions. They are among the biggest selling drugs in the world, which is part of the reason why they are so controversial and why so many people accuse drug companies from profiteering from them.

But do statins work in the first place?

Definitely. This group of drugs have been tested again and again, and have passed the standards set up by the highest drug authorities in the world, which are trained to look at designs of clinical trials. So yes, statins can reduce the following (according to a meta-analysis of all statin trials):

• All major cardiovascular events (including heart attacks and strokes) by 21%

• Major coronary events by 24%

• Stroke itself by 15%

• Death from any cardiovascular disease by 12%

• Death from coronary heart disease by 19%

• Non-fatal heart attacks by 26%

Why some people are up in arms about them is because of their side effects.

What side effects do statins have?

Most people won’t experience side effects. But some people have muscle cramps, tiredness, insomnia, headache, stomach upsets, etc. But the trials show that only a minority suffer from these. This is where you and your doctor have to weigh the benefit vs risk (side effect) ratio. Because of the hype surrounding statins, many people are quick to attribute any side effect they are suffering to a statin. The truth is many symptoms are unlikely to be caused by a statin. Talk to a cardiologist to understand if you should be a statin candidate and weigh all the evidence for yourself rather than listen to unsubstantiated claims.