Statins are a class of medication used to reduce the levels of unhealthy LDL cholesterol in your bloodstream. LDL cholesterol is a waxy, fatty substance that sticks to the blood vessels of your heart and the walls of your arteries. This can make your arteries harden.

It also may form plaques that block the normal flow of blood. If plaques break away from the wall of the artery or blood clots form on them, you can have a heart attack or stroke.

Statins reduce your body’s ability to manufacture LDL cholesterol. And they work. Statin therapy reduces the risk for a heart attack or other cardiovascular event by as much as 48 percent, depending on the level of risk factors you have. In fact, statins are so effective that nearly 32 million Americans take them.

Statins: The Pros and Cons

What’s the Safety Issue?

Only about 3 to 4 percent of people who take statins don’t do well on them, Harvard Health Publications report. For some of these individuals, statins aren’t effective in lowering cholesterol. Other people experience side effects.

Minor Side Effects

Common minor side effects include:

  • diarrhea
  • constipation
  • rash
  • headache

Liver Inflammation

In a small number of people, statins cause an increase in enzymes that the liver uses to help digestion. The liver can become inflamed and there’s risk of damage.

Muscle Inflammation

Statins can make muscles sore and tender to the touch. Very rarely, a condition called rhabdomyolysis occurs, in which there is serious damage to the muscles. Rhabdomyolysis is most often seen when people have other risk factors for the disorder, which could include slower kidney function.

Fatigue

Statins can also cause fatigue, especially in women. Fatigue seems to be related to exercise, unfortunately. In one study, researchers found that four in 10 women experienced a decrease in energy and increased fatigue from exercise when they took 20 mg of simvastatin daily. Your doctor should always check out any unexplained fatigue when you take a statin.

Can Statins Make You Tired?

Cognitive Problems

Some people may experience problems with their memory and concentration. These symptoms are not serious and can be reversed when discontinuing statins or switching to a different statin.

Diabetes Risk

Statins may cause an increase in blood sugar levels for some people. This could increase your risk for diabetes.

Kidney Risk

If you have kidney disease, you should know that you might need a different dose of statins. Some high-intensity statin doses are too high for those with kidney disease.

Which Statin Should I Take?

Statins have been studied exhaustively due to their wide use. Statins are safe for the majority of people, but there are differences between individual statins.

So, which statin is safest? It depends on a variety of factors. Some statins are safer for you if you have certain medical conditions. That is because there are known drug interactions between medications and individual statins.

6 Statin Drugs and Their Side Effects

The amount, or dose, you need for a particular statin to be effective is a factor, too. Your risk is less with lower doses of most statins.

Fewer Side Effects

According to a research review published in Circulation: Cardiovascular Quality and Outcomes, people who take simvastatin (Zocor) or pravastatin (Pravachol) may experience fewer side effects.

If You Have Many Risk Factors

Guidelines issued by the American College of Cardiology and American Heart Association indicate that the benefits of a high-intensity statin outweigh the risks if:

  • you have heart disease associated with hardening of the arteries (atherosclerosis)
  • your LDL cholesterol level is 190 mg/dL or greater
  • you have diabetes and high cholesterol levels and other risk factors for cardiovascular disease

If you need high-intensity statin therapy, your doctor is likely to prescribe atorvastatin (Lipitor) or rosuvastatin (Crestor).

If You Take Azole Antifungal Medication

Azole antifungal meds are often prescribed for fungal infections such as thrush and vaginal yeast infections. The American Academy of Family Physicians (AAFP) recommends avoiding lovastatin and simvastatin when taking the antifungal drugs itraconazole (Sporanox) and ketoconazole (Xolegel, Extina, Nizoral).

If You Take Protease Inhibitors

If you take protease inhibitors like atazanavir (Reyataz), ritonavir (Norvir), or (lopinavir/ritonavir (Kaletra) to treat HIV/AIDS, the AAFP advises that you avoid:

  • lovastatin (Mevacor, Altoprev)
  • pitavastatin (Livalo)
  • simvastatin (Zocor)

If You Take Macrolide Antibiotics

The AAFP recommends avoiding lovastatin (Mevacor, Altoprev) and simvastatin (Zocor) if you are taking macrolide antibiotics for bacterial infections. If you take atorvastatin or pitavastatin, you may need a dose adjustment.

If You Take Cyclosporine

Cyclosporine (Neoral) is used to treat a number of conditions, including lupus and rheumatoid arthritis. It’s also used to prevent organ rejection after transplants. The AAFP recommends avoiding pitavastatin and pravastatin if you are taking cyclosporine. Other statins including atorvastatin, lovastatin, rosuvastatin, and fluvastatin may require dose adjustments.

You Are Pregnant or Breast-Feeding

Statins are not recommended if you are pregnant or breast-feeding.

What’s Right for You?

A 2014 report by the National Lipid Association Task Force on Statin Safety states that the benefit you gain from statins depends on the level of risk you have for cardiovascular disease. The task force also says that the risk of adverse events from statins may outweigh the benefits only in people who have very low risk for cardiovascular disease.

Talk with your doctor about reducing cholesterol with diet and exercise. That is always your best option. If diet and exercise isn’t enough, discuss which statin is best for you given your level of risk, other medical conditions you may have, and medications you take.