Studies have shown that statins are effective in decreasing heart attacks and prolonging life. People who take statins after and even before a coronary event demonstrated reduced mortality and morbidity. Do you need a high does statin for heart health?
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Statin is highly recommended for all patients with an established coronary heart disease and for those at high risk for developing it. People at risk include people diagnosed with diabetes with elevated cholesterol in the blood, high blood pressure or a family with a history of premature deaths
What is a Statin?
Statins are HMG-CoA reductase inhibitors; a class of drugs prescribed to lower blood cholesterol levels.
Cholesterol is synthesized in the liver by a multi-step process. Statins work by blocking a key liver enzyme (HMG-CoA reductase) involved in this process, thereby slowing down the production of cholesterol in the liver. This encourages the liver to take extra cholesterol, low-density lipoprotein (LDL) cholesterol in particular, out of the blood, lowering the levels of LDL cholesterol present in the blood.
There are currently five statin drugs available on prescription. They are simvastatin (Zocor), pravastatin (Lipostat), Fluvastatin (Lescol), atorvastatin (Lipitor) and rosuvastatin (Crestor).
Statins also have numerous other effects, unrelated to lowering cholesterol, and include decreasing oxidative stress and vascular inflammation while increasing the stability of atherosclerotic lesions
Furthermore, Statins have a great potential to cross the blood-brain barrier and affect the central nervous system, due to its highly lipophilic property
Muscle Pain and Other Side Effects of Statin Use
Statins are generally safe and well tolerated. Clinical trials have indicated that they are relatively free of adverse effects. Most people will have no side effects, whereas others may experience mild symptoms of severe and life-threatening complications.
In rare occasions, high-dose statins can cause muscle cells to break down, a condition known as rhabdomyolysis. Clinical signs of rhabdomyolysis include severe muscle pain and tenderness on palpation, muscle weakness, and dark colored urine due to myoglobinuria. Rhabdomyolysis is associated with profoundly elevated creatinine kinase levels and acute renal failure secondary to myoglobinuria. Fatal rhabdomyolysis is the only substantial, well-defined cause of mortality associated with statin therapy
Statins can also cause your blood sugar level to slightly increase. Prolonged use may lead to type 2 diabetes. However, the benefit of taking a statin may potentially outweigh the risk. Clinical trials have shown that statin reduces the risk of coronary heart disease in diabetics.
Liver damage is a concern for doctors when recommending statins for their patients. Statins can cause an increase in liver enzymes. Low to moderate doses of statins are safe for patients and do not appear to raise liver enzymes. Common symptoms of liver damage include; dark-colored urine, upper abdominal pain, loss of appetite, yellowing of the eyes or skin, fatigue and weakness. Contact your physician immediately if you experience any of these symptoms.
Statins should not be used to treat children or prescribed to women who are pregnant, nursing or likely to become pregnant. As yet, there is conclusive evidence of an increased risk of birth defects or low birth weight following statin use. However, higher rates of spontaneous abortion and preterm delivery have been demonstrated in women being treated with statins. Current guidelines recommend that women wishing to get pregnant discontinue use of statins three months prior to attempting to conceive, or as soon as pregnancy is confirmed, due to the theoretical risk of fetal abnormality.
Other mild symptoms include skin rash, gastrointestinal upsets (constipation/ diarrhea), bloating, headaches, rash, and sleep disturbance.
Your cardiologist will conduct a blood test every six to twelve months to ensure that the drug is effectively lowering cholesterol levels. Patients on certain combinations of drugs, for example, a combination of statins and fibrates or statins and immunosuppressant drugs should be closely monitored for liver enzymes in the blood.
Cholesterol Medications Non-Statin.
There are many non-statin drugs. They include;
Niacin: Niacin is a B vitamin used to correct vitamin deficiency. It is commonly prescribed for people who have high cholesterol but can’t take statins. It is also used to boost HDL (good cholesterol) levels and decrease the levels of triglycerides and LDL (bad cholesterol). Niacin is contraindicated in people with liver disease, stomach ulcers, or active bleeding.
Omega – 3s: Omega-3 fatty acids are classes of polyunsaturated fatty acids found in fish oils, plant products, and certain supplements. Omega -3 fats are referred to as “healthy fats” because they appear to lower cholesterol level, which is associated with coronary heart disease. Omega-3 also decrease triglyceride levels in the blood. Omega-3 can be found in fatty fish like mackerel, trout, herring, sardines, tuna, and salmon
PCSK9 inhibitors, a key regulator of circulating LDL-C levels, have received considerable attention as promising non-statin therapeutic options for the management of hypercholesterolemia. The FDA has approved two of these drugs: alirocumab (Praluent) and evolocumab (Repatha). Evolocumab, in particular, has been approved as a preventative treatment for heart attacks, stroke, and coronary revascularizations in adults with cardiovascular disease.
Fibrates
Fibrates are a class of non-statin medications that lower triglyceride levels. Fibrates work by reducing the liver’s production of VLDL (very low-density lipoprotein) and enhancing the removal of triglycerides from the blood. Fibrates can irritate (inflame) the liver. The liver irritation usually is mild and reversible, but it occasionally can be severe enough to require stopping the drug. Side effects include nausea, stomach upset, and sometimes diarrhea. Gallstone is a common complication of prolonged usage of fibrates. It can also cause muscle damage when combined with statin medication. Doctors generally avoid combining a statin with fibrates because of concern over the higher risk of muscle damage with the combination.
Examples of fibrates include; clofibrate (Atromid-S), fenofibrate (Antara, Fenoglide, Lipofen, TriCor, Triglide, Trilipix), and gemfibrozil (Lopid).
References
CHAPTER IV: INDIVIDUAL VARIATIONS IN THE CHOLESTEROL CONTENT OF THE RED BLOOD CELLS UNDER DIFFERENT CONDITIONS. (2009). Acta Medica Scandinavica, 99(S99), 77-82. doi: 10.1111/j.0954-6820.1939.tb11826.x
DRUGS WHICH LOWER SERUM CHOLESTEROL. (1979). Inpharma, 177(1), 16-17. doi: 10.1007/bf03298397
Guyton, J. (2010). Combination regimens with statin, niacin, and intestinally active LDL-lowering drugs: alternatives to high-dose statin therapy?. Current Opinion In Lipidology, 21(4), 372-377. doi: 10.1097/mol.0b013e32833c1f16
Haramburu, F., Daveluy, A., & Miremont-Salame, G. (2015). Statins in pregnancy. BMJ, 350(mar17 11), h1484-h1484. doi: 10.1136/bmj.h1484
