(updated July 2020) A statin medication is a treatment for high cholesterol, a treatment for heart disease, for stroke, or to prevent these by a combination of lowering cholesterol, especially LDL and reducing inflammation and stabilizing plaque in the arteries.
Statins include atorvastatin (lipitor), simvastatin (zocor), rosuvastatin (Crestor), pravastatin (pravachol), etc.
Statins have been tested in multiple, lengthy research studies. They appear to reduce the likelihood of a second heart attack in individuals who’ve had one, reduce the progression of atherosclerotic plaque, lower bad cholesterol levels (LDL), increase good cholesterol levels (HDL), and stabilize plaque (less likely to rupture). The lower your LDL, usually, the less rapid your progression of coronary plaque or atherosclerosis.
On the downside, there is an increased risk of diabetes while on statins. A common side effect is muscle pain (myalgias), sometimes severe. Small numbers of people report concentration or memory issues and other side effects. The internet is full of people warning against statins. The internet is also full of a lot of misinformation, be careful.
Here’s the thing: heart disease is the number one killer in the U.S. Stroke is up there as well. Preventive holistic care includes eating better (see a blog entry on Diet, soon), exercising more, lowering stress levels (a hard one), losing weight (sometimes a harder one), and “natural” supplements including fish oils. Small doses of aspirin (“baby aspirin”) such as 81 milligrams a day may help.
Controlling blood pressure is also important, by either natural or medicinal means. But beyond these very important measures, statins appear to offer the best opportunity to prevent a first heart attack (or stroke) or deal with vascular disease that is advancing (e.g. preventing a second vascular event).
So again, I ask, who should take a statin? Recent American College of Cardiology/American Heart Association guidelines (2014) appear to expand the number of potential patients who are advised to use statin therapy while offering less clear guidelines as to what monitoring/goals that therapy should pursue.
In my practice, I take into account these and other guidelines and expert opinion from lectures I’ve attended by top cardiologists at Cedars-Sinai and at the Lipidologists of Los Angeles Meetings I attend regularly. (who knew that’s a specialty too?). Family history is obviously very important as is personal preference. Cholesterol levels, age, presence of diabetes, and male sex are risk factors. I also rely on the amount of plaque detected by the CCS (coronary calcium score, see that blog entry, upcoming) test that I often order in appropriate patients. This can be done at 50, sometimes younger, sometimes older, depending on family history, gender, and other risk factors (e.g. diabetes).
Putting it all together, I’m looking to prescribe a statin where it has the potential to substantially reduce the risk of vascular disease (or disease progression) in individuals who are at higher risk of this based upon their personal history, laboratory testing, and imaging, family history, and response to non-medication therapy where appropriate.
It is a judgment call and like everything in medicine involves considering a risk/benefit equation where a doctor tries to choose treatments whose benefits are likely to be greater than their risks for an individual patient.
Other medications in this area are zetia and PCSK-9 inhibitors. The former is generic and not a statin. The latter is new and expensive and powerful
I hope this helps.
David Schechter MD
author, Think Away Your Pain
(Blog discussions are for general educational purposes and cannot replace an office visit and discussion with your physician)