What Are Statins?

Statins are prescription drugs designed to lower cholesterol. Statins function by inhibiting an enzyme needed to produce cholesterol in the liver. Without the help of that enzyme, your body cannot transform the fat you consume into cholesterol.

Having too much cholesterol circulating in your arteries is dangerous because it can build up plaque. A buildup of plaque can prevent blood from flowing properly and can increase the risk of a heart attack.

Types of Statins Available

There are several types of statins available. They include:

High-intensity statins:

  • atorvastatin (Lipitor)
  • rosuvastatin (Crestor)

Moderate-intensity statins:

  • fluvastatin (Lescol)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • simvastatin (Zocor)

Although all statins work in the same way, your body might respond better to one type than another. This is why doctors sometimes try several types of statins before they can find the right one for you.

Some are more likely to interact with other drugs or organic compounds. For example, the statins Lipitor (atorvastatin), Pravachol (pravastatin), and Zocor (simvastatin) can interact with grapefruit juice. This is according to the Food and Drug Administration. The interaction can be very dangerous. Mixing these drugs with grapefruit can increase the amount of medication in the bloodstream and cause serious side effects.

Risks and Side Effects

Although most people benefit from statins, these drugs can have side effects. The most serious side effects occur in people who are taking other medications or who have an underlying health condition. Many side effects go away as your body adapts to the medication.

According to the Mayo Clinic, the most common side effect of statins is muscle and joint aches and pains. The medication can also cause nausea and vomiting. More serious side effects include liver and kidney damage, an increase in blood sugar, and neurological side effects. In some people, statins can cause a breakdown in muscle cells and lead to permanent muscle damage.

Cholesterol Absorption Inhibitors

If statins are not an option or you suffer from side effects, your doctor can prescribe a different drug to treat high cholesterol. A common alternative is a cholesterol absorption inhibitor.

These drugs prevent your small intestine from properly absorbing the cholesterol you consume. If it can’t be absorbed, it won’t reach your bloodstream. The only one available on the market is the drug ezetimibe (Zetia). This drug can be combined with statins to produce faster results. However, many doctors prescribe ezetimibe alone and combine it with a low-fat diet to help reduce cholesterol.

Sequestrants

Another alternative to statins is bile acid-binding resins or sequestrants. These drugs work by binding to the bile in your intestines, blocking cholesterol absorption into your bloodstream.

According to the National Library of Medicine, these are the oldest drugs available to treat high cholesterol. They are not as effective as other drugs, so they are often used by people with levels of cholesterol that are only slightly higher than normal.

These drugs can also cause vitamin deficiencies when taken for a long time. Vitamin K deficiency is especially dangerous because this is the vitamin that helps stop bleeding.

Medications for High Triglycerides

Many people who have high cholesterol also have high triglycerides (a type of fat found in your blood). Some medications can help lower this type of fat directly. Once these levels go down, the total amount of cholesterol is often lowered.

A common prescription for high triglycerides is niacin or vitamin B-3. Niacin can help lower bad cholesterol (LDL) and increase good cholesterol (HDL).

This is a good option for people who don’t respond well to other medications because its side effects are mild. People taking this medication might experience the following:

  • flushing of the face
  • headaches
  • upset stomach
  • sweating
  • dizziness
  • lightheadedness
  • nausea

When more aggressive treatment is necessary to treat high triglycerides, a class of medications called fibrates is often prescribed.

Also, dietary supplements of omega3 fatty acids — found in fish oil — have been shown to reduce triglyceride levels.

Lifestyle Changes

There are a number of lifestyle changes you can make that can help in lowering your cholesterol. Lifestyle changes play an important role in fighting high cholesterol.

To help lower cholesterol, start by losing excess weight and eating heart-healthy foods. Eating a heart-healthy diet means decreasing the amount of saturated (animal) fat you eat. It also means increasing fiber, fruits, vegetables, whole grains, and fish in your diet. If you are overweight, losing as little as 5 to 10 pounds can help reduce your cholesterol levels. Other important lifestyle changes to consider are to stop smoking and to reduce the amount of alcohol you consume.

Getting exercise every day is another way to fight high cholesterol. Exercise has other health benefits as well. Adding exercise can start with something as simple as taking a short walk each day.

Natural Remedies

Natural remedies have been shown to have some cholesterol-lowering effects as well. However, they should be in addition to lifestyle changes. According to the Mayo Clinic, there are not a lot to choose from. Some of these include:

  • garlic
  • oat bran
  • artichoke
  • barley
  • sitostanol
  • beta-sitosterol
  • blond psyllium

With your doctor’s approval, these can be easily added into your diet. It is important to note that you should continue any medication you have been prescribed by your doctor.

Choosing Treatment

Your best choice of treatment depends on many factors. Before your doctor chooses a prescription medication, they will look at several things. These factors include: your family medical history, your risk for heart disease, and your lifestyle.

Many doctors prefer to start with changes to diet and exercise. If those changes don’t have enough effect, you might start taking medication to help the process along. 

Takeaway

There are a number of different types of statins and alternatives. The important thing when deciding on the best treatment for you is to talk openly with your doctor. Changes to your diet and exercise along with natural remedies may help you if statins cause you to have uncomfortable side effects. However, never make any changes without consulting your doctor first. The American Heart Association stresses that you should also not stop taking your medications if you start to feel better. Only your doctor can advise you when you can lower your dosage or make any changes or additions to your medications.

You asked, we answered

  • In what type of health situation(s) should someone consider an alternative to statins?
  • An alternative to statins should only be considered if the high- or moderate-intensity statins cannot be tolerated. High blood pressure is closely associated with an increased chance of heart attack, stroke, and other diseases. If you can tolerate taking a statin, you will decrease these chances. The only health situation where statins may not be considered is in an individual under the age of 65, with a BMI of 28 or less, with no history of smoking, a moderate to low level of alcohol use, and no other chronic ailment.

    - Dr. George Krucik