Statins, Your First Line of Defense

For physicians, statins are usually the drugs of choice for improving cholesterol levels. The primary goal of all lipid therapy is reduction of LDL cholesterol. Since statins lower LDL cholesterol more than any other type of drug while raising HDL and lowering triglycerdies, physicians typically consider statins first. Statins, like many lifestyle changes, improve all aspects of one's lipid profile and therefore have the most beneficial cardiovascular effect.

Statins typically are the least prone to side effects of various medical therapies, despite still having significant potential effects. Statins accomplish this reduction of LDL by blocking an enzyme, HMG-CoA reductase, which produces cholesterol in the liver. With this enzyme inhibited, the liver manufactures less cholesterol. Since the liver needs cholesterol, it removes more cholesterol from the bloodstream to replace what it is blocked from making. In this manner, statins reduce LDL production and also boost the body's ability to remove excess LDL cholesterol circulating in the bloodstream.

Statin Research Studies

Depending on the dosage, statins have shown the ability to reduce LDL levels up to 60 percent. A higher dosage is also associated with more significant side effects. Aggressive statin therapy has proved to reduce cardiac risk in very high-risk individuals by up to 60 percent and stroke risk by almost 20 percent.

Other large studies have shown that statin use decreased the risk of heart attack, stroke, peripheral arterial disease, and death in men and women, in middle-aged and older persons, and in people who had not yet had a heart attack as well as those who had survived a significant heart event. With results like these, physician confidence in the use of statins is high. They are generally considered a very cost-effective medication, second only to aspirin, in the prevention of heart attack and stroke.

Statin Types and Usage

Types of statins include but are not limited to lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin. These are marketed under the brand names Mevacor, Zocor, Pravachol, Lescol, and Lipitor, respectively. Since the body makes more cholesterol at night than during the day, patients are usually directed to take statins in a single dose at the evening meal or at bedtime.

Typically, statins impact cholesterol levels the most by about four to six weeks. After about six to eight weeks, your health care provider will retest your cholesterol levels to determine the effectiveness of the statin therapy and whether the dose requires adjustment.

Side Effects of Statins

Most people do not have serious side effects when taking statins. Some people may experience constipation, stomach pain, cramps, or gas. These symptoms are usually mild to moderate, however, and they go away over time. More serious side effects can result from an increase in liver enzymes that can lead to liver toxicity. Because of this risk, it's important to have your liver function tested periodically while you are on statin therapy. People with active chronic liver disease should not take statins.

Another serious side effect comes from statin myopathy. Muscle soreness, pain, and weakness may occur. In extreme cases, muscle cells can break down and release the protein myoglobin into the blood. Myoglobin in the urine can contribute to impaired kidney function, eventually leading to kidney failure. The risk of this occurring increases when statins are taken at high dosages or combined with certain other cholesterol medications.

Certain studies have shown a possible increased risk of amnesia and other memory-related problems while on statins. While this is possibly a rare side effect, more research is required. Since cholesterol is essential to cell membrane structure, scientists suggest that reducing cholesterol may affect neurological functioning.

Since statins affect the cell membrane's synthesis of cholesterol, women who are pregnant or planning to become pregnant should absolutely avoid them.

Avoid consuming grapefruit juice, grapefruits, or tangelos (a hybrid grapefruit) when you are taking statins, as these fruits can affect how the drug is metabolized. Grapefruits contain a chemical that affects certain digestive enzymes as drugs are broken down in the intestinal tract and liver. Interestingly, this effect can occur even if you wait twenty-four hours to take the medication. Therefore, if you are taking statins, it is best to avoid grapefruit products entirely.

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