Cholesterol-lowering medicines, statins

Cholesterol-lowering medicines, statins

Introduction

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.

LDL cholesterol is often referred to as “bad cholesterol”, and statins reduce the production of it inside the liver.

Why have I been offered statins?

Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels. It is the most common cause of death in the UK. The main types of CVD are:

  • coronary heart disease – when the blood supply to the heart becomes restricted
  • angina – sharp chest pain, caused by coronary heart disease
  • heart attacks – when the supply of blood to the heart is suddenly blocked
  • stroke – when the supply of blood to the brain becomes blocked

Your doctor may recommend taking statins if you’ve been diagnosed with a form of CVD, or if your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures (see below) haven’t helped reduce this risk. 

Read more about when statins may be recommended.

Taking statins

Statins come as tablets that are taken once a day. The tablets should normally be taken at the same time each day  most people take them just before going to bed.

In most cases, treatment with statins will need to continue for life, as stopping the medication will cause your cholesterol to return to a high level within a few weeks.

If you ever forget to take your dose, do not take an extra one to make up for it. Just take your next dose as usual the following day.

If you accidentally take too many statin tablets (more than your usual daily dose), contact your doctor or pharmacist for advice, or call NHS 111.

Cautions and interactions

Statins can sometimes interact with other medicines, increasing the risk of unpleasant side effects, such as muscle damage. Some types of statin can also interact with grapefruit juice.

It is very important to read the information leaflet that comes with your medication, to check if there are any interactions you should be aware of. If in doubt, contact your GP or pharmacist for advice.

Read more about things to consider when taking statins.

Side effects of statins

Many people who take statins experience no or very few side effects. Others experience some troublesome – but usually minor – side effects, such as an upset stomach, headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if they’re offered to you.

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

The risks of any side effects also have to be balanced against the benefits of preventing serious problems. A review of scientific studies into the effectiveness of statins found that around one in every 50 people who take the medication for five years will avoid a serious event, such as a heart attack or stroke, as a result.

Read more about the side effects of statins.

Alternatives to statins

If you’re at risk of developing CVD in the near future, your doctor will usually recommend lifestyle measures to reduce this risk before they suggest taking statins.

Lifestyle measures that can help reduce your cholesterol level and CVD risk include:

Statins may be recommended if these measures don’t help.

Read more about treating high cholesterol and preventing CVD.

When statins may be used

Statins may be recommended if you have cardiovascular disease (CVD) or have a high risk of developing it in the next 10 years.

Cardiovascular disease

CVD is a general term that describes a disease of the heart or blood vessels that is often caused by high cholesterol. It is the most common cause of death in the UK.

The main types of CVD are:

Statins cannot cure these conditions, but they can help prevent them from getting worse or recurring in people who have been diagnosed with them.

They can also reduce the chance of these conditions developing in the first place in people at risk (see below). 

Statins are usually used in combination with lifestyle measures such as eating a healthy diet low in saturated fat, exercising regularly, stopping smoking and moderating your alcohol consumption.

People at risk of cardiovascular disease 

If you don’t have any form of CVD, statins may still be recommended if you’re thought to be at a high risk of developing the condition in the future.

The current recommendation is that you should be offered statins if there is at least a one in 10 chance of you developing CVD at some point in the next 10 years and lifestyle measures such as exercising regularly and eating a healthy diet haven’t helped reduce this risk.

Your GP may recommend carrying out a formal assessment of your CVD risk if they think you may be at an increased risk of CVD, based on your personal and family medical history.

For this formal assessment, your GP or practice nurse will use special CVD risk assessment computer software that takes into account factors such as:

  • your age
  • your gender
  • your ethnic group, as some have an increased risk of CVD
  • your weight and height
  • if you smoke or have previously smoked
  • if you have a family history of CVD
  • your blood pressure
  • your blood cholesterol levels
  • if you have certain long-term conditions  such as diabetes, chronic kidney disease, rheumatoid arthritis and atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate)

Read more about health checks for adults.  

Other uses

Statins can also be used to treat people with a condition called familial hypercholesterolaemia.

This is an inherited condition caused by a genetic fault, which leads to high cholesterol levels, even in people who have a generally healthy lifestyle.

Cautions and interactions

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 statins can affect your liver, and this is more likely to cause serious problems if you already have a severely damaged liver.

Before you start taking statins, your doctor should carry out a blood test to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver three months after treatment begins, and undergo another after 12 months.

Pregnancy and breastfeeding

Statins should not be taken by women who are pregnant or breastfeeding, as there is no firm evidence on whether it is safe to do so.

If you do become pregnant while taking statins, contact your GP for advice.

People at an increased risk of side effects

Statins should be taken with caution if you are at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. This can lead to kidney damage (rhabdomyolysis).

Things that can increase this risk include:

  • being over 70 years old
  • having a history of liver disease
  • regularly drinking large quantities of alcohol
  • having a history of muscle-related 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, there is a chance that frequent monitoring may be needed to check for complications. A lower dose of statin may also be recommended.

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Read more about the side effects of statins.

Interactions

Statins can react unpredictably with certain other substances (known as “interacting”), potentially increasing the risk of serious side effects, such as muscle damage.

Medications that can interact with some types of statin include:

  • certain antibiotics and antifungals 
  • certain HIV medications 
  • warfarin  a medication commonly use to prevent blood clots
  • ciclosporin  a medication that suppresses the immune system, which is used to treat a wide range of conditions including psoriasis and rheumatoid arthritis
  • danazol  a synthetic hormone medication used to treat conditions such as endometriosis
  • verapamil and diltiazem  types of medication called calcium channel blockers, which are used to treat various conditions affecting the heart and blood vessels
  • amiodarone  a medication sometimes used to treat irregular heartbeats
  • fibrates  medications that, like statins, help to reduce cholesterol levels in the blood

If you are taking statins and need to take one of these medications, your doctor may prescribe an alternative statin or prescribe your current statin at a lower dosage. In some cases, they may recommend that you temporarily stop taking your statin.

Food and alcohol

Grapefruit juice can affect some statins and increase your risk of side effects. Your doctor may advise you to avoid it or to only consume it in small quantities.

There are no known interactions between statins and alcohol.

Side effects of statins

Like all medications, statins can cause side effects. However, most people tolerate them well and don’t experience any problems.

You should discuss the benefits and risks of taking statins with your doctor before you start taking the 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.

Some of the main side effects of statins are described below; however, this is not an exhaustive list and some of these will not necessarily apply to the specific statin you are taking. For information on the side effects of a particular statin, check the information leaflet that comes with your medication. 

Common side effects

Although side effects can vary between different statins, common side effects (which affect up to 1 in 10 people) include:

However, it’s not clear whether most of the common problems people experience when taking statins are actually caused by the medication itself. A study has suggested that many side effects are similar, no matter if a statin or placebo (dummy medication) is taken. For more information, see the article “Statins side effects are minimal, study argues”.

Uncommon side effects

Uncommon side effects of statins (which may affect up to 1 in 100 people) include:

  • being sick
  • loss of appetite or weight gain
  • difficulty sleeping (insomnia) or having nightmares
  • dizziness – if you experience this, do not drive or use tools and machinery
  • loss of sensation or tingling in the nerve endings of the hands and feet (peripheral neuropathy)
  • memory problems
  • blurred vision – if you experience this, do not drive or use tools and machinery
  • ringing in the ears
  • inflammation of the liver (hepatitis), which can cause flu-like symptoms
  • inflammation of the pancreas (pancreatitis), which can cause stomach pain
  • skin problems, such as acne or an itchy red rash
  • feeling unusually tired or physically weak

Rare side effects

Rare side effects of statins (which may affect up to 1 in 1,000 people) include:

  • visual disturbances
  • bleeding or bruising easily
  • yellowing of the skin and eyes (jaundice)

Muscle effects

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

Your doctor will carry out a blood test to measure a substance in your blood called creatine 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 sometimes lead to a rise in CK, so tell your 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.