When Your Doctor Orders Cholesterol-Lowering Medications

When Your Doctor Orders Cholesterol-Lowering Medications
Do you really need statins to lower cholesterol?
By Gina Shaw
Reviewed by Brunilda Nazario, MD

You’ve just left your doctor’s office with a prescription for a statin medication to help lower your cholesterol. But you may be nervous. You’ve heard that you’ll have to take this cholesterol-lowering medication for the rest of your life. And your doctor noted that statins, like all medicine, can cause side effects.

Why should you take a statin? Can’t you just improve your cholesterol levels by eating right and exercising? The answer is yes -- and no. Healthy cholesterol and triglyceride levels look like this:

Total cholesterol: less than 200 mg/dL

HDL (“good” cholesterol): 40 mg/dL or more for men, 50 or more for women

LDL (“bad” cholesterol): less than 130 mg/dL

Triglycerides: less than 150 mg/dL

Many people can get their cholesterol and triglyceride levels into these healthy ranges through a combination of a healthy diet and an active lifestyle. But for many others, these lifestyle changes help, but are not enough.
Measuring the Benefits of Statins, Diet, and Exercise

“Lifestyle changes certainly are the cornerstone of cholesterol reduction,” says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center.

Exercising, eating a healthy diet, and losing weight can result in:

* A 5% to 10% reduction in LDL cholesterol
* A 10% to 30% reduction in triglycerides

But for those with very high LDL cholesterol or triglycerides, those lifestyle measures may be insufficient. “If your lipid levels are way out of whack, for example, reducing your LDL by 10% may not get you down to a healthy level,” Miller says.

* Statin medications act quickly and can help reduce LDL or “bad” cholesterol by up to 50% or more.
* Statins also help increase HDL or “good” cholesterol by up to 15%.

If you’re making healthy lifestyle changes at the same time, says Miller, you should see major changes in your cholesterol levels within two to four weeks after beginning lipid-lowering therapy.

“Statins are very simple: you take them once a day, and their effects are quite profound,” says Patrick McBride, MD, MPH, director of the preventive cardiology program and the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.

“Not only do statins improve your cholesterol levels, but they reduce your risk of heart attack, stroke, and cardiovascular events. They’re one of the great success stories of modern medicine,” says McBride.

Most recently, the JUPITER trial showed that statins can also slash the risk of heart attack nearly in half for people with normal cholesterol but high levels of a protein associated with inflammation.
Statin Side Effects and Other Worries

What about side effects from taking statins? It’s true that any medication comes with side effects. Side effects most commonly seen with statins are headache, GI tract upset, muscle and joint aches, or rash. Very rarely, patients may experience muscle or liver damage.
Statin Side Effects and Other Worries continued...

Overall, however, the risks of statins are low. “They’re less than the risks associated with taking two aspirin a day,” says McBride. The benefits are well established, with hundreds of thousands of people studied in clinical trials. The benefits enormously outweigh the risks for the right person.”

In fact, although there is a very small risk of liver damage from statins, McBride notes that many other people see a benefit to their liver after taking statins, because they had previously built up fat or triglycerides in the liver, which can lead to inflammation and damage.

When there is liver damage or muscle weakness because of the use of statins, those side effects all reverse themselves when the patient stops taking the statin.

What about the idea that you’ll have to take statins for the rest of your life? That’s the wrong way of looking at it, McBride says.

“I have very few patients who stay on the same medications for five years, let alone the rest of their life,” he says. “New medications and new options will come along. You’ll change. We’ll change. For the near term, you will be on statins every day, but as new things develop, we’ll adapt.”
Questions to Ask Your Doctor About Cholesterol Medication

If you’re concerned about why your doctor has prescribed statins to lower your cholesterol, here are a few questions to ask:

* Why do you think I’m a good candidate for this medication?
* What will this do for me and my body?
* What are the potential benefits versus the risks to me specifically?
* Will this have any interactions with anything else I’m taking? (Be sure to tell our doctor if you’re taking over-the-counter medications or supplements. Several supplements can interact with statins.)
* What are the long-term goals of therapy?
* Can I take a supplement instead of a statin to lower my cholesterol?
* Will supplements interfere with the effects of the statin?

Miller tells his patients to look at statins as they would a vitamin to boost health. “In many ways, that’s what it is,” he says, “and it’s the only one that we know that works so well to improve cholesterol and lower cardiovascular risk.”


SOURCES:

Michael Miller, MD, director, the Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore.

Patrick McBride, MD, MPH, director, preventive cardiology program and cholesterol clinic, the University of Wisconsin School of Medicine and Public Health, Madison, Wis.

American Heart Association, Atlanta.
Reviewed on December 30, 2008