10 Things Your Doctor Won’t Tell You About Statins

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Statins are among the most commonly prescribed drugs in the world for a reason: they can lower your LDL cholesterol (the “bad cholesterol”) by 20 – 60%. Statins are also helpful for the prevention of heart disease in some people with high cholesterol.

Popular statin medications include generic atorvastatin (Lipitor) and simvastatin (Zocor) and brand-name Crestor and Livalo.

Time with your doctor can be limited, so you may not have heard all of the upsides and downsides when you were prescribed a statin. Here are 10 lesser-known, interesting, and sometimes disconcerting facts about statins.

  1. Is expensive better? Crestor is no better than the generic statin drugs. In fact, the generics perform better in studies, presumably because people take them regularly when they can actually afford them. Generic drugs have been shown to be clinically equivalent to their brand-name counterparts—they work the same to treat your cholesterol. A recent large study showed that you are more likely to take a generic statin long-term, which leads to an 8% lower rate of heart attack or death compared to brand-name statin drugs.
  2. They may cause fuzzy brain, but wait . . . People taking certain statins have reported memory loss, but the evidence is not clear on this. Many studies show that statins may play a role in the prevention of dementia. Knowing this, if you have memory loss associated with a lipophilic statin (simvastatin, atorvastatin, or fluvastatin) it is reasonable to ask your doctor about trying a more hydrophilic statin (pravastatin or Crestor) which don’t appear to have that problem.
  3. You might not need them. Treatment targets were abandoned in the last year. This means we are no longer chasing a target number for LDL cholesterol. New guidelines recommend that your doctor prescribe them to you based on a CV (cardiovascular) risk calculator.
  4. Life sentence. If you do need them, you take them for life. You need to listen to your doctor who asks you to watch your diet, increase exercise, and quit smoking, but statins are also an important part of improving cardiovascular health in those who need them. If you stop taking your statin, your LDL cholesterol will go back to where it was before you started taking the meds.
  5. Dementia. Some observational studies have suggested that statins may decrease the risk of dementia and at least one small randomized trial has suggested that statins may slow the progression of dementia. This, I like.
  6. Not all statins carry the risk of muscle problems. Crestor (rosuvastatin) 20 mg daily has the same risk of muscle toxicity as placebo.
  7. Grapefruit juice yay or nay? You’ve heard this for years. Grapefruit juice inhibits an enzyme which affects the breakdown of your statin drug. The good news is that daily consumption of eight ounces or less of grapefruit juice, or half of a grapefruit or less, is unlikely to increase the risk of an adverse event or muscle injury.
  8. Vitamin D. Studies suggest that low vitamin D levels may be associated with muscle problems from statins. Vitamin D supplements have also been shown to improve symptoms of statin myopathy (muscle disease or soreness). If you have muscle aches from a statin, have your vitamin D level checked. Start on replacement vitamin D if you are deficient and consider giving statins another try.
  9. Coenzyme Q10 doesn’t really help the muscle problem. Despite many loyal followers taking CoQ10, there is no evidence that it improves or prevents statin-associated muscle side effects.
  10. Diabetes. This gets tricky. It appears likely that statins do come with a small increased risk of developing diabetes, and that risk is slightly greater with high-dose statins. The problem is that statins reduce cardiovascular events in patients with diabetes, so the benefit outweighs the increased risk for diabetes.

Bonus: There may be other non-statin options soon. New cholesterol meds Praluent (alirocumab) and Repatha (evolocumab) are getting lots of attention, and may the biggest thing since statins. Only Praluent has been approved by the FDA so far, though Repatha has also been recommended for approval. You should know that they will both be very expensive injectable medications, and they aren’t for everyone. For now, Praluent is only indicated if you have inherited high cholesterol, known as heterozygous familial hypercholesterolemia (HeFH), or if you are considered high risk (after a heart attack or stroke) and need additional help lowering your LDL cholesterol.

Dr O.

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