When diet and exercise alone are not enough to reduce cholesterol to goal levels, doctors often prescribe anti-cholesterol medications (statins). Statins taken orally, usually once a day, are extremely effective in lowering LDL cholesterol levels by blocking its production by the liver.
Success is monitored by period blood tests.
Apart from lowering cholesterol statins have effects on potential regression or at least stabilization of atherosclerosis, they seem to reduce the risk of heart attack, stroke or even death.
The most commonly used statins are:
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Fluvastatin (Lescol)
- Lovastatin (Mevacor, Altoprev)
- Pravastatin (Pravachol)
Should I be on a statin?
Whether you need to be on a statin depends on your cholesterol level, along with your other risk factors for cardiovascular disease.
New guidelines from the American College of Cardiology and American Heart Association focus on four main groups of people who may be helped by statins:
- People who already have cardiovascular disease. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, mini-strokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.
- People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL or higher.
- People who have diabetes. This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL, especially if they have evidence of vascular disease.
- People who have a higher 10-year risk of heart attack. This group includes people who have an LDL above 100 mg/dL (1.8 mmol/L) and whose 10-year risk of a heart attack is 7.5% or higher. Check Cardiovascular Risk Calculator
Can I stop medication when cholesterol goes down?
You may think that once your cholesterol goes down, you can stop taking medication. But if your cholesterol levels have decreased after you take a statin, you'll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.
The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may help you lower your cholesterol without continuing to take the medication, but don't make any changes to your medications without talking to your doctor first.
What are the side effects of statins?
The most common side effects leading to stopping of a statin medication are intolerable muscle and joint aches. There are multiple approved statins, so trying a different one is usually suggested before giving up due to side effects. Occasionally, statin use causes an increase in liver enzymes, indicating liver damage. If the increase is only mild, you can continue to take the drug. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.
It is uncertain, but there is some evidence that statins may induce diabetes and cognitive dysfunction. All these risks are far outweighed by the benefits of decreased morbidity and mortality from cardiovascular disease.
What if statins don’t work for me?
If statins don’t work for you, due to side effects or insufficient results, as your physician about PCSK9 inhibitors. PCSK9 inhibitors appear to lower cholesterol levels 60% more than statins. While promising, these drugs are taken by injection, not orally, and can be very expensive. They are not yet recommended as first-line treatment for most people with hyperlipidemia, but may be suitable for some.