Statins are cholesterol-lowering medications. They work by blocking an enzyme that makes cholesterol.
Statins, also known as HMG-CoA reductase inhibitors, are prescription medications that help improve cholesterol levels.
Statins block an enzyme in your body that creates cholesterol. This action reduces your total cholesterol level, including your low-density lipoprotein (LDL), or “bad” cholesterol level. It also increases your level of high-density lipoprotein (HDL), which is considered “good” cholesterol. These effects can reduce your risk of heart attack or stroke.
The very first statin, called lovastatin, was approved in the United States in 1987. Since then, other statins have been developed and approved.
These drugs all come in either a tablet or capsule that you take by mouth. In addition to statin-only drugs, some drugs include a statin in combination with another drug.
The following statins are currently available in the United States:
- atorvastatin (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Altoprev, Mevacor)
- pravastatin (Pravachol)
- rosuvastatin calcium (Crestor)
- simvastatin (Zocor)
Statins can also be found in combination medications, including Caduet (amlodipine/atorvastatin) and Vytorin (simvastatin/ezetimibe).
Not all statins are created equal. Certain statins are more potent: They reduce LDL and total cholesterol levels more than other statins.
Some statins have been shown to reduce the risk of heart attack and stroke in people who have never had these events. This use is called primary prevention. With secondary prevention, the drugs are used to prevent the recurrence of heart attack or stroke.
Doctors usually only recommend statin combination products when you need dual therapy. For example, if your cholesterol levels do not respond as they should to treatment with just a statin, your doctor may have you take a drug that combines a statin with ezetimibe.
Your doctor will choose an appropriate statin based on factors such as:
- your age
- other health conditions you have
- how much cholesterol-lowering effect you need
- how well you tolerate a statin
- other drugs you take
It’s rare, but some children have a genetic condition that causes their cholesterol levels to be greatly increased. If your child needs to take a statin to lower their cholesterol, their doctor may recommend one of the following:
- atorvastatin, for use in children ages 10–17 years
- fluvastatin, for use in children ages 10–16 years (for girls, at least 1 year after their first period)
- lovastatin, for use in children ages 10–17 years (for girls, at least 1 year after their first period)
- pravastatin, for use in children ages 8–18 years
- rosuvastatin, for use in children ages 7–17 years
- simvastatin, for use in children ages 10–17 years
Existing health conditions
Certain health conditions or risks for conditions can factor into your doctor’s recommendation. Your doctor may suggest a high potency statin therapy, which works more aggressively to lower your cholesterol level, if you:
- have active heart disease
- have very high LDL levels (190 mg/dL or greater)
- are between the ages of 40 and 75 years, have diabetes and an LDL level between 70 mg/dL and 189 mg/dL
- are between the ages of 40 and 75 years, have an LDL level between 70 mg/dL and 189 mg/dL, and have a high risk of developing heart disease
Doctors typically prescribe atorvastatin and rosuvastatin for high potency statin therapy.
If you can’t tolerate a high potency statin therapy or you have diabetes and a lower risk of developing heart disease, your doctor may recommend a moderate potency statin therapy. This may include:
Low potency statin therapy is also available. It includes lower doses of:
Statins may either be water- or fat-soluble.
Water-soluble statins include rosuvastatin and pravastatin. Fat-soluble statins include atorvastatin, simvastatin, and lovastatin.
Drug solubility may be a consideration when deciding on statin therapy. Water-soluble may cause fewer side effects than fat-soluble statins.
Other medications you take
Your doctor also needs to know the other medications you take to recommend a statin for you. It’s important to tell your doctor about all drugs you take, including over-the-counter drugs, supplements, and herbs.
If you take multiple medications, your doctor might recommend a statin that is less likely to interact with other drugs, such as pravastatin and rosuvastatin.
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Statins may not be suitable for everyone. People who may not be able to take statins include:
- pregnant people (in most cases)
- breastfeeding people
- people with active liver disease
If you need to take a statin to help lower your cholesterol levels, you have several options. Give your doctor a complete medical history to help them decide the most appropriate statin for you. Important points to discuss include:
- your cholesterol levels
- your history or family history of heart disease
- all medications you take
- any medical conditions you have
These factors can affect your ability to take a statin and the statin options available to you. Your doctor should be able to start you on a statin that not only safely improves your cholesterol levels and lowers your risk of heart attack and stroke, but also works well with other medications you take.
You won’t be able to judge whether your statin is working based on how you feel. So, it’s important to keep appointments with your doctor to monitor your statin therapy.
Your doctor will perform blood tests that measure your cholesterol levels to make sure your statin is working. Statins usually take 2–4 weeks to become fully effective, including after dosage changes.
Talk with your doctor about any side effects you have. They may be able to adjust your dosage, switch you to another statin, or stop your statin therapy to give you a different cholesterol-lowering medication.
Statins are a kind of drug used to lower cholesterol. They can help lower the risk of heart attack and stroke.
If your doctor recommends statin therapy, they will work with you to choose an appropriate statin that accounts for factors like any underlying health conditions, other medications you may be taking, your age, and your tolerance of statins.