Cholesterol lowering medicines - Statins

Statins are a group of medicines that can help lower rates of low-density lipoprotein (LDL) cholesterol (so called ‘bad cholesterol’) in the blood.

Information written and reviewed by Certified Doctors.

Contents

Introduction

Statins are a group of medicines that can help lower rates of low-density lipoprotein (LDL) cholesterol (so called ‘bad cholesterol’) in the blood.

They do this by reducing the production of LDL cholesterol inside the liver.

Why do I need statins?

Having high-rates of LDL cholesterol is potentially dangerous as it can lead to hardening and narrowing of the arteries, which is known as atherosclerosis.

Atherosclerosis increases the risk of more serious, and possibly life-threatening, conditions, such as:

Statin therapy is usually recommended in the following groups of people:

  • people with pre-existing heart disease
  • people who are healthy but have a high risk of developing heart disease at a later date
  • people who have a high cholesterol level because of a faulty gene they have inherited from their parents – this is known as familial hypercholesterolaemia

Read more about who should take statins.

Alternatives

Statins are not the only option for treating high cholesterol. Alternative treatments include:

  • eating a healthy diet, low in saturated fats
  • increasing the amount of omega-3 fatty acids in your diet
  • other prescribed medications

Read more detailed information about treating high cholesterol.

Side effects

Many people who take statins experience no or very few side effects.

Others do experience troublesome but usually minor side effects, such as an upset stomach, headache or problems sleeping (insomnia).

Cases that involve more serious side effects, such as kidney failure, tend to get a great deal of media coverage, but these cases are rare. The British Heart Foundation reports than only 1 in every 10,000 people who take statins will experience a potentially dangerous side effect.

Also the risks of any side effects have to be balanced against the benefits of preventing serious conditions such as heart attack and stroke.

It is estimated that statins save 7,000 lives a year in the UK.

Read more about the side effects of statins and things to consider when taking statins.

Interactions

Statins can sometimes interact with other medicines and cause unpleasant reactions such as muscle damage. Some types can also interact with grapefruit juice.

It is very important to read the information leaflet that comes with your medication to see if there are any interactions you need to be aware of.

If in doubt contact your doctor or pharmacist for advice.

Read more about interactions with statins.

Uses

Statins may be recommended if:

  • you have coronary heart disease – where the blood supply to the heart becomes restricted, resulting in a sharp chest pain known as angina; angina can often be triggered during exercise
  • you do not currently have heart disease but are thought to be at high risk of developing it in the future
  • you have high cholesterol that is failing to respond to other treatments (such as changing your diet and quitting smoking)

Statins can also reduce your risk of having:

  • stroke – where the supply of blood to the brain becomes blocked
  • peripheral arterial disease, also known as peripheral vascular disease. This occurs when there is a blockage in the arteries to your limbs (usually your legs), which can cause cramping in the affecting limbs

Statins cannot cure conditions such as coronary heart disease but they can help prevent them from getting worse.

If you have a history of a previous stroke or heart attack, they can also reduce the risk of you having a future stroke or heart attack.

Reducing the risk

Statins may also be recommended if you are currently healthy but have a higher than average risk of having heart disease in future.

The current recommendation is that you should be treated with statins if there is at least a 1 in 5 chance of you developing heart disease at some point in the next ten years.

Health professionals can make an assessment of your personal risk of developing heart disease based on the following factors:

  • your age
  • your sex
  • your ethnic group – some ethnic groups, such as South Asian, have an increased risk of developing a heart disease
  • your weight
  • whether you are a smoker or smoked in the past
  • whether you have a family history of heart disease
  • your blood pressure
  • your blood cholesterol levels
  • whether you have certain long-term conditions, such as diabetes, chronic kidney disease, rheumatoid arthritis and /or atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate)

A risk assessment is recommended for:

  • all adults over the age of 40
  • people with a family history of heart disease that developed at an early age
  • people with a family history of familial hypercholesterolaemia (see below)

High cholesterol

Statins may be recommended if blood tests show you have high levels of low-density lipoprotein (LDL) cholesterol (so called ‘bad cholesterol’) in your blood and lifestyle changes such as diet, exercise and stopping smoking have failed to reduce the levels.

Your lifestyle can increase your risk of developing high blood cholesterol. This includes:

  • an unhealthy diet: some foods already contain cholesterol (known as dietary cholesterol) but it is the amount of saturated fat in your diet which is more important
  • smoking: a chemical found in cigarettes called acrolein stops high-density lipoprotein (HDL) from transporting LDL to the liver, leading to narrowing of the arteries (atherosclerosis)
  • having diabetes or high blood pressure (hypertension)
  • having a family history of stroke or heart disease

There is also an inherited condition known as familial hypercholesterolaemia (FH). This can cause high cholesterol even in someone who eats healthily.

Read more about the causes of high cholesterol.

Special considerations

Statins should not be taken if you have severe liver disease or blood tests suggest your liver may not be working properly.

This is because your body uses the liver to remove statins from the body and if there is a serious problem with your liver it could lead to a dangerous build-up of statins.

Before you start taking a statin, your doctor should ensure your liver is in relatively good condition. This will involve a blood test to check for the liver enzyme (substance in the blood) serum transaminase.

Simvastatin

The statin called simvastatin should not be taken if you are taking medicines that affect how the liver breaks it down. These include:

  • some antibiotics (medicines for infection), including erythromycin, clarithromycin, itraconazole and ketoconazole
  • some medicines for HIV (human immunodeficiency virus) infection, including indinavir, lopinavir, ritonavir and saquinavir

If you take these medicines and also need treatment for high cholesterol, you may take one of the other statins.

Pregnancy and breastfeeding

Statins should not be taken by women who are pregnant or breastfeeding as it is unclear whether it would be safe to do so.

If you do become pregnant when taking a statin you should contact your doctor for advice.

Using statins with caution

Statins should be taken with caution if you are at an increased risk of developing rare side effects where the tissues of your muscles become damaged and painful (myopathy), which can cause damage to your kidneys (rhabdomyolysis).

These risk factors include:

  • being over 70 years old
  • having a history of liver disease
  • drinking large quantities of alcohol
  • having a history of muscle side-effects when taking a statin or fibrate (another type of medicine for high cholesterol)
  • having a family history of myopathy or rhabdomyolysis

If one or more of these apply to you then you may need frequent monitoring for complications. A lower dose of statin may also be recommended.

If you have an underactive thyroid, treatment may be delayed until your thyroid function is restored to normal. This because an underactive thyroid can lead to an high cholesterol condition which could naturally drop when normal thyroid function is restored. Also, statins can cause muscle damage in people with an underactive thyroid.

Side-effects

Statins are generally well tolerated and most people will not experience any side effects.

Muscle effects

Statins can occasionally cause inflammation (swelling) and damage to your muscles. Speak to your doctor if you experience muscle pain, tenderness or weakness that cannot be explained (for example, not due to physical work).

Your doctor will carry out a blood test to measure a substance in your blood called creatinine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.

If the level of CK in your blood is more than five times the normal level, your doctor may advise you to stop taking the statin. (Regular exercise can sometime lead to a rise in CK so tell the doctor if you have been exercising a lot).

Once your CK level has returned to normal, your doctor may suggest you start taking the statin again, but at a lower dose.

Common side effects

Although side effects can vary between different statins, common side effects (affecting between 1 in 10 people and 1 in 100 people) can include:

  • nosebleeds
  • cold-like symptoms
  • headache
  • feeling sick
  • problems with the digestive system such as constipation, diarrhoea, indigestion and/or flatulence (passing wind)
  • muscle and joint pain
  • difficulties sleeping (insomnia)

Uncommon side effects

Uncommon side effects of statins (affecting between 1 in 100 people and 1 in 1,000 people) include:

  • being sick
  • loss of appetite
  • nightmares
  • dizzinessif you are affected by dizziness do not drive, use tools or machinery
  • inflammation of the liver (hepatitis) which can cause flu-like symptoms
  • ringing in the ears
  • blurred vision – again, do not drive if your vision is blurred
  • skin problems, such as acne or an itchy red skin rash
  • changes to your normal pattern of urination, such as having to urinate more frequently
  • feeling usually tired or physically weak

Rare side effects

Rare side effects of statins (affecting less than 1 in 1,000 people) include:

  • visual disturbance
  • loss of sensation and pain in the nerve endings of the hands and feet (peripheral neuropathy)
  • bruising more easily
  • yellowing of the skin and eyes (jaundice)
  • memory problems

This is not an exhaustive list and the pattern and frequency of side effects can vary depending on the type of statin you are taking. So you should carefully read the information leaflet that comes with your medication.

If you find certain side effects particularly troublesome you should talk to the doctor in charge of your care. Your dose may need to be adjusted or you may need a different type of statin.

While side effects can sometimes be troublesome it is important to also appreciate the very real benefits statins do provide.

Research has found that in high-risk groups for heart disease, for every eight people who take a statin, one of those people would have otherwise had a (possible fatal) heart attack or stroke.

Interactions with other medicines

Antibiotics

Some antibiotics, including erythromycin, clarithromycin, itraconazole, ketoconazole and miconazole, can increase your risk of muscle damage if taken with atorvastatin or simvastatin.

Speak to your doctor if you are taking atorvastatin or simvastatin and need to take one of these antibiotics. Your doctor may advise you to stop taking atorvastatin or simvastatin or take a lower dose of the statin while you are on the course of antibiotics.

The antibiotic daptomycin should also not be taken in combination with any statin.

Warfarin

Statins can enhance the effect of warfarin, which may increase your risk of bleeding.

You should have regular blood tests to monitor the effect of your statin on the warfarin, especially when starting or stopping a statin or when changing the dose of statin.

Dosage

Take statins as directed on the packet or patient information leaflet, or as directed by your doctor or pharmacist.

Missed dose

If you forget to take your dose of statin, take that dose as soon as you remember and then continue to take your course of statins as normal.

If you have to take two doses closer together than normal, there is an increased risk of side effects.

The patient information leaflet that comes with your medicine should give you advice on what to do. If you are still concerned, speak to your doctor or pharmacist.

Accidentally taking one extra dose

Accidentally taking one extra dose of statins is unlikely to cause you harm. If you are concerned, speak to your doctor or pharmacist.

Accidentally taking more than one extra dose

If you accidentally take more than one extra dose of your statins, contact your doctor.

Content supplied by NHS Choices