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.
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 have been studied exhaustively due to their wide use. Statins are safe for most 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.
The amount, or dose, you need for a statin to be effective is a factor, too. Your risk is less with lower doses of most statins.
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) and 75 years of age or lower
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)
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 psoriasis 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.
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:
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 and pain
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 reduced thyroid function, liver disease, and slower kidney function.
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.
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.
Statins may cause an increase in blood sugar levels for some people. This could increase your risk for diabetes.
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.
You are pregnant or breast-feeding
Statins are not recommended if you are pregnant or breast-feeding.
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.