Statins
Statins are drugs which lower the level of cholesterol in your blood. There are different types of statins, but they all work in the same way.
Why do I need to lower my cholesterol?
Statins reduce the amount of ‘bad cholesterol’ your body makes. Cholesterol is essential for your body to work well, but too much ‘bad cholesterol’ (called low-density lipoprotein or LDL) is unhealthy.
High levels of ‘bad cholesterol’ in your blood can lead to fatty deposits building up in your arteries. This can increase your risk of developing cardiovascular disease which includes conditions such as coronary heart disease (angina and heart attack) and stroke.
Your body will always make cholesterol, so if you stop taking a statin, it’s likely your cholesterol levels will rise. If you are prescribed a statin, you need to take it every day. Statins are most beneficial when you take them on a long-term basis.
Who needs to take statins?
Some GPs prescribe statins to people who are healthy, but at high risk of developing cardiovascular disease. Statins can help lower their risk.
You can ask your GP for a health check to find out if you are at risk of cardiovascular disease.
Your GP or cardiologist can also prescribe statins to prevent you having further problems if you have already had a heart attack, a stroke orperipheral artery disease, or if you havediabetes.
When should I take my statin?
It’s important to take your medication regularly as prescribed. The statins that doctors prescribe most often should be taken at night. Check with your doctor or pharmacist when you should be taking your statin.
Most statins come as tablets. The most common one is simvastatin.
Look up your medication on the Medicine Guides website.
Do I need to avoid other drugs or any foods?
Check with your doctor or pharmacist before you take any other drugs. Taking certain drugs together may affect how well they work.
If you’re taking simvastatin, avoid grapefruit and grapefruit juice as they can increase your risk of side effects.
Do statins have side effects?
Like all medication, statins have potential side effects that are usually mild, easy to recognise, reversible and very rarely dangerous. Statins are among the safest and the most studied drugs available today. You should tell your GP if your symptoms are getting worse or if you develop any new symptoms.
Statins target the liver cells where cholesterol is made. Before you start taking statins, you will have a blood test to check how well your liver works. You will have a follow-up blood test a few months later. If your liver is affected, your doctor may want to reduce your dose or change your statin to another kind of medication that lowers your cholesterol.
Find out about other possible side effects from our Statins information sheet.
Can I buy statins over the counter?
Low-dose statins are available at pharmacies without a prescription, but they are not a substitute for prescription statins or for making lifestyle changes to reduce your cholesterol level. If you are at high risk of heart disease, your doctor may prescribe a statin for you.
What's the difference between the types of statins?
All types of statins do the same job. Lots of people don’t need a strong statin to reduce their cholesterol level. Your GP or cardiologist will find the right statin for you, depending on your medical history and the cholesterol level they think you should aim for.
If you’re sensitive to one statin, you might not be sensitive to another. You should have a blood test after any change of statin to see how effectively the new drug is lowering your cholesterol.
Are statins safe for women?
Statins are equally safe and effective for men and women, but if you’re pregnant, breastfeeding or planning a pregnancy, you shouldn’t take them. If you’re already taking statins, but would like to become pregnant, speak to your GP first.
How else can I lower my cholesterol?
You can also lower your cholesterol by:
eating a healthy, balanced diet
maintaining a healthy weight and body shape
doing regular physical activity
High-dose statins 'increase Type 2 diabetes risk'
Hundreds of thousands of people on high-dose statins are increasing their chances of developing diabetes, researchers warn today.
By Stephen Adams, Medical Correspondent
22 Jun 2011
Taking 80mg of two types of widely prescribed statin - simvastatin or atorvastatin - increases the chance of developing Type 2 diabetes by 12 per cent over five years, compared to taking moderate dose statins (20mg or 40mg), they found.
However, experts said patients should still take the cholesterol-lowering drugs as the benefits in terms of reducing the risk of heart attacks and strokes outweighed the risks.
In England about 200,000 people, mainly those who have already suffered a heart attack or stroke, take 80mg daily doses of simvastatin or atorvastatin.
Today's study, published in the Journal of the American Medical Association (JAMA), looked at almost 33,000 people on moderate or high-dose statins in five separate studies. None had diabetes to start with.
The researchers calculated that for every 498 people who took high-dose statins for a year, an extra person would develop diabetes than if they had taken moderate-dose statins.
However, if the same group took high-dose statins it would prevent at least three more cardiovascular events, compared to them taking moderate doses.
The academics, led by Dr David Preiss of Glasgow University, concluded: "Net cardiovascular benefit in high-risk individuals will still strongly favour statin therapy."
Their research complements a study, also involving Dr Preiss, published in The Lancet last year. It found that taking moderate doses of statins increased the risk of developing Type 2 diabetes by nine per cent over four years, compared with taking a sugar pill.
The researchers remain unclear about how statins appear to trigger diabetes in some individuals.
Professor Peter Weissberg, Medical Director at the British Heart Foundation, said: "Nobody should stop taking their prescribed statins because of the evidence shown in this research."
Dr Sharlin Ahmed, research liaison officer at The Stroke Association, said: "Every patient needs to be assessed and treated on a case by case basis and the risk of developing diabetes as a result of taking statins should be weighed up against the potential risk of having a heart attack or stroke."
Libby Dowling, clinical advisor at Diabetes UK, said: ”What we don’t know from this research is whether the people being prescribed the high-dose statins were overweight as having a large waist puts you at increased risk of developing Type 2 diabetes anyway.
“The benefits of statins for people at increased risk of heart disease outweigh the risk of developing Type 2 diabetes so we would not recommend people stop taking them on the basis of this research.”
Millions taking statins 'needlessly'
Up to 3 million people are taking statins needlessly, doctors warn today in a comprehensive study that suggests they are ineffective in many cases and could be doing more harm than good.
Doctors are being called on to stop giving patients the drugs unnecessarilyPhoto: ANDREW CROWLEY
By Stephen Adams, Medical Correspondent
19 Jan 2011
An authoritative review shows there is little evidence that the cholesterol-lowering drugs protect people who are not already at a high risk of heart disease.
As a result, the NHS is wasting large amounts of money on giving the drugs to the “worried well”, the researchers warn. In some cases, the side-effects of taking statins could outweigh the benefits, they say.
A number of studies have linked statins to liver problems, acute kidney failure and muscle damage.
Statins are thought to be taken by one in three people over 40. Up to seven million people in England take them, costing the NHS at least £450 million a year. A large proportion of these are at a low risk of heart problems and take the drugs to ward off future disease.
Experts who advocate the use of statins say they have helped prolong thousands of lives by preventing heart attacks and other cardiovascular events.
But a wide-ranging review of previous studies, published today in the journal The Cochrane Library, urges “caution” among GPs who prescribe them. It concludes that there is no “strong evidence” to suggest that statins reduce coronary heart disease deaths among those who have not suffered a heart attack or other cardiovascular event in the past.
Just one life is currently saved for every 1,000 people who take them each year, the report says.
Shah Ebrahim, a professor of public health at the London School of Hygiene and Tropical Medicine, who co-wrote the report, called on doctors to stop giving patients the drugs unnecessarily.
“What we are looking for is for GPs to review their patients’ cardiovascular disease risk levels, so we are not needlessly prescribing these treatments to people,” he said.
“Do we want to waste money on something that is taking up resources? Because it looks like a waste of money to me.”
The National Institute for Health and Clinical Excellence (Nice) recommends that doctors prescribe statins to those whose chance of suffering a heart attack, stroke or heart disease over the next 10 years is at least 20 per cent higher than normal.
Doctors are free to prescribe them to lower-risk patients and regularly do so. Statins can also be bought over pharmacy counters without a prescription.
No data exist on how many lower-risk people take statins, although it is thought to be several million as the drugs have often been hailed as a catch-all treatment that can help a variety of conditions.
Prof Ebrahim said he agreed with Nice’s advice, but argued against statin use among those at a lower risk.
He suggested that, among these people, statins could do more harm than good. “There are some small trials that show evidence of cognitive lapses and depression,” he said.
Previous studies have also indicated statins could increase the chance of liver problems, acute kidney failure and a type of muscle damage in some people, and can increase the chance of haemorrhagic stroke – bleeding on the brain – in people who have already had one.
The authors also accused pharmaceutical companies of cherry-picking studies on statins that showed a positive impact for the sake of profit.
Fiona Taylor, also of the London School of Hygiene and Tropical Medicine, said: “We know that industry-sponsored trials are more likely to report favourable results for drugs versus placebos.”
Prof Ebrahim added: “Their aim is to get the maximum number of people on the drugs. It’s an old game.”
However, Prof Colin Baigent, of the Clinical Trial Service Unit at Oxford University, said the Cochrane review was already “out of date”.
Last year, the unit published results in The Lancet showing statins reduced deaths from all causes by 10 per cent over five years. This was mainly due to a 20 per cent drop in the number of deaths from coronary heart disease.
He said: “Statins are one of the great success stories of the last decade or two, and they have prevented many thousands of deaths.”
He dismissed Prof Ebrahim’s concerns over pharmaceutical firms’ control of statin trials as a “conspiracy theory” and said that testing for every potential harm was practically impossible. Experts said patients currently taking statins should consult their GP before deciding whether to carry on. Last week, Prof Nicholas Wald, the innovator of the “polypill” for preventing cardiovascular disease, told a meeting at the Royal Society in London that people should be able to get hold of such medicines more easily.
Last year, analysis of clinical trial data found that taking high doses of a statin called simvastatin, used by millions of Britons, could lead to fatal kidney failure and muscle damage.
The study published today reviewed data from 14 trials involving 34,272 patients, comparing statins against placebos or usual care.
The Cochrane Library is published by Wiley-Blackwell on behalf of the Cochrane Collaboration, which describes itself as “the world’s leading producer of systematic [medical] reviews”.
Statins and Other Lipid Lowering Drugs
Statin drugs reduce the blood cholesterol level. This helps to prevent heart disease, stroke, and related diseases in people at increased risk. Most people are not troubled by side-effects. However, if you take a statin, tell a doctor if you develop unexplained muscle pain, tenderness or weakness (which may be due to a rare, but serious, side-effect).What are cholesterol, lipids and atheroma?
Cholesterol is a lipid (fat chemical) that is made in the liver from fatty foods that we eat. A certain amount of cholesterol is present in the bloodstream. You need some cholesterol to keep healthy. Cholesterol is one factor involved in forming atheroma.
Patches of atheroma are like small fatty lumps which develop within the inside lining of arteries (blood vessels). A patch of atheroma makes an artery narrower, which may reduce the blood flow. A build up of atheroma can cause heart diseases such as angina and heart attacks, stroke, transient ischaemic attack (TIA or 'mini-stroke'), and peripheral vascular disease (narrowing of the arteries to the legs).
See separate leaflet called 'Cholesterol' for details.
What are statins and how do they work?
Statins are a group of drugs that are commonly used to reduce the level of cholesterol in the blood. They include atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin. They each have different brand names. Statins work by blocking the action of a certain enzyme (chemical) in the liver, which is needed to make cholesterol.
Who should take a statin?
Your doctor will advise if you should take a statin. One is usually advised if:
- You have an atheroma-related disease. That is, a cardiovascular disease such as angina or peripheral vascular disease, or have had a myocardial infarction (heart attack), stroke or TIA. A statin helps to reduce the risk of these conditions getting worse. Or, it can delay the progression of the disease.
- You have a high increased risk of developing an atheroma-related disease. For example, if you have diabetes, or other risk factors. See separate leaflet called 'Cardiovascular Health Risk Assessment' for details.
Note: a statin is just one factor in reducing your risk of developing cardiovascular diseases. Just as important are: eating a healthy diet, not smoking, taking regular exercise, losing weight if you are overweight, reducing blood pressure if it is high, and taking a daily low dose of aspirin if advised to do so. See separate leaflet called 'Preventing Cardiovascular Diseases' for details.
What happens when I take a statin?
You should have a blood test before starting treatment. This checks the level of cholesterol. It also checks if your liver is working properly. After starting treatment, you should have a blood test within 1-3 months, and again at 12 months. The blood test is to check that the liver has not been affected by the medication. The blood may also be checked to measure the cholesterol level to see how well the statin is working.
What is the target cholesterol level to aim for?
There is no actual target cholesterol blood level for people who do not already have cardiovascular disease.
If you do have a cardiovascular disease the aim, if possible, is to reduce total cholesterol to less than 4.0 mmol/L and low-density lipoprotein (LDL) cholesterol to less than 2.0 mmol/L. If the target is not reached at first, the dose may need to be increased or a different preparation used.
What are the possible side-effects or problems with statins?
Most people who take a statin have no side-effects, or only minor ones. Read the information leaflet that comes with your particular brand for a full list of possible side-effects. These include: headache, pins and needles, abdominal pain, bloating, diarrhoea, feeling sick, and a rash.
Some notable points to remember:
- Tell your doctor if you have any unexpected muscle pains, tenderness, cramps or weakness. This is because a rare side-effect of statins is a severe form of muscle inflammation.
- You should not take a statin if you have active liver disease, if you are are pregnant or intend to be pregnant, or if you are breast-feeding. You should stop a statin if you develop liver disease.
- Do not eat grapefruit or drink grapefruit juice if you are taking a statin. A chemical in grapefruit can increase the level of statin in the bloodstream which can make side-effects from the statin more likely.
- Various other drugs that you may take may interfere with statin drugs. For example, some antibiotics and ciclosporin. The doses of either the statin or the other interacting drug may need to be adjusted. Therefore, if you are prescribed (or buy) another drug, remind the doctor or pharmacist that you are on a statin in case it is one where an interaction may be possible.
- Tell a doctor if you develop chest symptoms such as unexplained dyspnoea (shortness of breath) or cough. This is because, in very rare cases, statins may cause a disease called interstitial lung disease.
Other drugs to reduce cholesterol and other lipids