1. What types of side effects do statins typically cause?

Common side effects of statin therapy include headache, mild muscle and joint pain, gas (flatulence), nausea, indigestion, and insomnia.

In rare cases, statins can cause liver damage or a severe side effect called rhabdomyolysis. Someone experiencing rhabdomyolysis would notice an unexplained muscle weakness and severe muscle tenderness. It’s important to seek immediate medical attention for these symptoms since rhabdomyolysis can cause life-threatening muscle damage and kidney failure.

2. What types of drug interactions exist for statins?

The most common statins — including atorvastatin (Lipitor), simvastatin (Zocor), and lovastatin (Altoprev)— are metabolized, or removed, from the body with an enzyme called CYP 3A4. Drugs that inhibit this enzyme cause the concentration of statins to increase in the body. The increased concentration can raise the risk of dangerous side effects.

The following drugs inhibit CYP 3A4:

  • amiodarone (Nexterone)
  • antibiotics, including clarithromycin (Biaxin) and erythromycin (Ery-tab)
  • antifungals, including fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
  • calcium channel blockers, including diltiazem (Cardizem) and verapamil (Verelan)
  • protease inhibitors, including atazanavir (Reyataz), darunavir (Prezista), ritonavir (Norvir), and others in this class

Eating grapefruit or drinking grapefruit juice should also be avoided, since grapefruit products are CYP 3A4 inhibitors.

3. What other types of drugs treat high cholesterol?

Statins are considered one of the most powerful drug classes to treat high cholesterol. They can reduce low-density lipoprotein (LDL) levels, sometimes referred to as bad cholesterol, by as much as 20 to 60 percent. They also help to prevent heart attacks and strokes by preventing plaque buildups in blood vessels from rupturing.

Other types of drugs that treat high cholesterol include:

  • PCSK9 inhibitors. This new class of drugs includes alirocumab (Praluent) and evolocumab (Repatha), both of which have to be injected every two to four weeks. Initial research shows that they can lower cholesterol as much as 60 to 70 percent, but they are very expensive and only available in an injectable form.
  • Bile acid sequestrants. These medications — including colesevelam (Welchol), cholestyramine (Questran), and colestipol (Colestid) — work in the body’s intestines to bind bile acids and prevent absorption of cholesterol from foods. They have interactions with many medications because they bind to them and prevent them from absorbing. They also commonly cause unwanted side effects including nausea, bloating, and cramping.
  • Ezetimibe (Zetia). This medication makes it impossible for the body to absorb cholesterol from foods that are eaten. It’s often used in combination with statins.
  • Nicotinic acid (niacin). This is a vitamin that is used when the maximum dose of statin isn’t reducing cholesterol levels enough. It commonly causes side effects such as nausea, itching, numbness, tingling, and flushing, or redness in the face.
  • Fibrates. These medications — including fenofibrate (Triglide), fenofibric acid (Trilipix), and gemfibrozil (Lopid) — can lower triglycerides and raise levels of high-density lipoproteins (HDLs), also called good cholesterol. They are normally not given with statins due to increased risk of side effects.
  • Fish oil. This over-the-counter supplement helps to reduce triglyceride levels and decrease the risk of coronary heart disease.

4. What are the risks of not treating or managing high cholesterol?

High cholesterol places a great stress on your heart. It raises the likelihood of experiencing coronary heart disease, heart attacks, strokes, and possibly death.

5. Are there foods that I should avoid?

A heart-healthy diet that is low in saturated fats and trans fats can help lower high cholesterol. To reduce these fats, your diet should limit red meats and whole-milk dairy products. It’s best to avoid fried foods and to cook with healthy oils, such as vegetable oil.

Diets that are high in vegetables, fruits, poultry, fish, whole grains, and nuts, but low in sugar from both beverages and foods, often already limit saturated and trans fats.

6. Are there any long-term risks to taking statins?

Studies haven’t found any evidence of long-term risks related to statin treatment, outside of side effects that are associated with statin therapy for any amount of time. Whenever someone is taking a statin, they are at risk for the rare side effect of rhabdomyolysis.

7. What do I need to know about taking statins if I have type 2 diabetes or high blood pressure?

Even when cholesterol levels are normal, statins are very important for people with type 2 diabetes or high blood pressure. Research has shown that people with type 2 diabetes or high blood pressure who take a statin have decreased risk for heart attacks, strokes, and death.

When starting a statin, it’s possible for your blood sugars to rise slightly. Your doctor will work with you to monitor your blood sugar and make any adjustments to your diabetes medications to ensure that your sugars are controlled.

8. Does exercise affect high cholesterol?

Overall, regular exercise promotes good health. Implementing a regular exercise routine can affect high cholesterol. Regular exercise has been found to decrease triglyceride levels and raise HDL, or good cholesterol, levels. The changes in cholesterol levels that can be measured from lifestyle modifications are normally seen after 6 to 12 months.

9. Does stress affect high cholesterol?

Studies have found a relationship between stress and an increase in LDL, or bad cholesterol. Results suggest that high levels of stress can contribute to high cholesterol, and cortisol might be to blame for the correlation.

Cortisol is a hormone released in your body when it undergoes stress. The release of cortisol causes an increase in the body’s blood sugar levels. If blood sugar levels remain consistently high over a period of time, they contribute to triglyceride production, which then creates more cholesterol.

10. How often should I have my cholesterol levels checked if I know that I have high cholesterol?

High cholesterol is determined using a test called a lipid panel, which is a type of blood test. Another blood test should be done 4 to 12 weeks after starting statin therapy. Your doctor will then determine a regimen for your blood tests based on your individual risk factors and your blood test results. You can expect your blood to be tested regularly every 3 to 12 months to monitor your cholesterol levels.

Dr. Dena Westphalen is a clinical pharmacist with interests in global health, travel health and vaccinations, nootropics, and custom compounded medications. In 2017, she graduated from Creighton University with her doctor of pharmacy degree, and is currently working as an ambulatory care pharmacist. She has volunteered in Honduras, providing public health education, and has received the Natural Medicines Recognition Award. Dr. Westphalen was also a scholarship recipient for IACP Compounders on Capitol Hill. In her spare time, she enjoys playing ice hockey and the acoustic guitar.