Statins: What you need to know about cholesterol medications

HHigh cholesterol is a prime example of having too much of a good thing. Our bodies make this substance naturally in the liver and then transport it throughout the body to perform many functions, including hormone regulation, tissue repair, and vitamin absorption. When the system is working properly, cholesterol can promote overall health. But when a certain type called low-density lipoprotein—LDL, sometimes called the “bad” type—is overproduced, it doesn’t just block the “good” type known as high-density lipoprotein (LDL). HDL), but can also begin to accumulate. in the arteries and form thick and hard deposits. This narrows the blood circulation and increases the risk of blood clots forming, which can lead to a heart attack or stroke. The U.S. Centers for Disease Control and Prevention (CDC) notes that about 93 million American adults have high cholesterol, which is about 36% of the adult population in the United States.

High cholesterol rarely presents with symptoms in the early stages, which is why know your cholesterol level and lower your LDL if it’s too high. Important for heart health. For many people, a drug called a statin may be a recommended measure for cardiovascular risk prevention. First approved by the U.S. Food and Drug Administration in 1985, these drugs work by blocking a substance your body uses to make cholesterol, which can lower blood levels. LDL cholesterol and also helps stabilize plaques on blood vessels so they don’t break off. and become problematic.

According to the CDC, statin use has increased over the past decade, and nearly 39 million Americans take statins daily. Usage increased over the age of 40 since heart risk tends to escalate as we age. However, a statin prescription is not a guarantee for everyone.

Here are answers to five key questions about this popular drug, along with advice on when to talk to your doctor.

How do statins work?

Like reducing factory production, statins work by reducing the amount of cholesterol produced by the liver. They also help the liver get rid of cholesterol already in the blood, which can reduce your chances of developing deposits in your arteries.

This is different from other cholesterol-lowering drugs because instead of trying to get rid of excess cholesterol once it is produced, statins target the source of that production.

For example, injectable drugs called PCSK9 inhibitors lower cholesterol by blocking LDL receptors in the body, which leads to the amount of cholesterol circulating in the blood. There is also niacin, sometimes called nicotinic acid, which works by increasing levels of HDL cholesterol – resulting in a decrease in LDL cholesterol.

Read more: Things to know about high cholesterol in children

Have thoughts on who should take statins change over the past few years?

Adriana Quinones-Camacho, a cardiologist at NYU Langone in New York, says as more and more statins become available — there are now seven options — and use of these drugs has increased, so has the understanding of researchers. The science of cholesterol and heart disease is also evolving.

“The more we learn about heart disease and cholesterolproposals become more nuanced,” she notes. “In the past, total cholesterol levels, and especially LDL, might have been the biggest consideration when using statins, but that is no longer the case.”

For example, age is an extremely important variable. Research published in the journal Clinical epidemiology in 2016 showed that statin prescribing rates rose the most for people aged 50 to 59, while slowing slightly for those aged 60 to 74.

Research over the past decade has also clarified the strong link between diabetes and heart disease, especially if someone also has high cholesterol. If you have diabetes, you’re already twice as likely to have heart disease or stroke — and at a younger age — than someone without the condition. Quinones-Camacho says additional factors like high cholesterol and blood pressure may prompt your doctor to recommend more statins.

“As we have more data and evidence about the effects of cholesterol on the body, as well as studying these other variables, it gives us more information that we can use to tailor statin recommendations to individual patients,” she added.

Will someone with high cholesterol automatically become a candidate for statins?

In August 2022, the US Preventive Services Task Force recommended that people 40 to 75 years of age at high risk for cardiovascular disease consult a healthcare professional about taking statins to prevent a first heart attack or stroke.

While high LDL and low HDL counts are two of the main considerations when recommending statins, they are not, said Dr Kevin Ferentz, chair of family medicine and primary care physician at GBMC Health Partners Primary Care. must be the only problems. in Maryland.

“High cholesterol is just one factor in the development of heart disease,” he said. “Other things—like smoking, high blood pressure, and diabetes—play a role, too.” Dr Jennifer Wong, cardiologist and medical director of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical adds: “Your doctor will consider your age, general physical condition, family history of heart diseases and the presence of other chronic diseases. Center in California.

Combining all these factors is not done through intuition—there is a standard risk calculator used by medical professionals to look at 9 different factors and calculate the probability of developing the disease heart for 10 years. In some cases, Wong said, this score can prompt people to make important lifestyle changes that can reduce disease risk without the use of medication.

Most notably, quitting smoking is a huge benefit to heart health that can lower LDL cholesterol on its own. When combined with healthy eating and regular exercise, patients can achieve better cholesterol levels within just a few months, while also improving blood pressure and diabetes symptoms if either symptom is present. there.

However, factors that cannot be changed – such as genetics and age – may be more prominent and increase risk to the point of encouraging statin use, Wong said. And one factor that almost always drives statin recommendations? There was a previous cardiac event.

“If someone has ever had a heart attack or stroke, they are most likely a candidate for a statin, regardless of their cholesterol level,” she said. “If they also have hypertension or diabetes in addition to heart disease, they will almost certainly be advised to take a statin.”

Read more: How to lower your cholesterol naturally

What are the most common side effects?

Ferentz adds that statins have been increasingly used over the past 40 years, with a wealth of data on side effects and the balance between reward and risk. In general, statins tend to be well tolerated, and the majority of people who take them have no side effects, especially if they are well monitored.

Some people who start taking statins experience increased blood sugar levels. For most people, this is not a concern, says Wong, but if you pre-diabetes and that mild elevation increases the risk of developing Type 2 diabetes, which may necessitate a change in treatment. However, she adds, the conversation with your healthcare provider will revolve around whether the benefits of taking a statin outweigh the risks.

In addition, doctors usually check liver function before people start taking statins and recheck it every year. “Sometimes statins raise concerns about liver function,” says Ferentz. In certain cases, such as if the patient is suffering from liver damage, statins can be stopped altogether and replaced with other medications.

The main side effect associated with statins is myopathy, a neuromuscular disorder that causes muscle pain. Statin-related muscle symptoms can include mild to moderate pain, fatigue, weakness, and night cramps and can be confirmed through blood testing.

Research shows that up to 25% of statin users experience some type of muscle problem. In rare cases, this can progress to more serious conditions such as rhabdomyolysis, in which damaged muscle tissue releases compounds such as proteins and electrolytes into the bloodstream, potentially affects the kidneys and heart.

However, that only happens if the muscle pain is left untreated, Wong said. Most people who are experiencing higher levels of discomfort and side effects can be switched to another statin or even a non-statin cholesterol-lowering option that can resolve muscle problems.

“Every drug has side effects, and statins are no exception. While muscle pain is the most common symptom, she’s also heard of trouble sleeping, digestive upset, and dizziness. “In all of these cases, we are fortunate to have some kind of statin on hand,” she said. “So it’s easy to change to something that might work better. Sometimes, just reducing the dose can have a big effect.”

When should you talk to your doctor?

Even if you’re generally healthy—you don’t have any other chronic diseases, eat healthy, don’t smoke, and exercise regularly—you can still have high cholesterol. Remember that it rarely presents with symptoms. It’s important to check your cholesterol after age 40, but Quinones-Camacho also recommends knowing your numbers decades in advance.

Most likely, young people won’t be on statins, but monitoring baseline cholesterol levels can help reduce overall cardiovascular health risks.

Regardless of your age, talk to your doctor if you have a family history of heart disease. You’ll also want to keep your cholesterol levels high if you currently or previously smoked, or if you have high blood pressure, diabetes, a less-than-ideal diet, or sedentary behavior.

“Ultimately, like everything in medicine, statin use comes down to what’s best for an individual,” Quinones-Camacho says. “Two people of the same age with the same cholesterol can be managed very differently in terms of a cholesterol-lowering plan.” As with everything else in medicine, prevention is better than cure. “So the sooner you talk to your doctor, the better.”

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