Top 10 Questions About Cholesterol Medications, aka The 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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Whether you take atorvastatin (Lipitor), simvastatin (Zocor), or Crestor (rosuvastatin), most statin medications—used for lowering cholesterol—have a very similar risk and benefit profile.

Almost one in four Americans now take a statin, so many of you may have questions about a new or existing prescription. Here are the answers to the most common questions I am asked about statin drugs by my patients:

  1. Will they hurt my liver? Out of the ordinary liver tests are only seen in fewer than 1 in 100 patients taking statin drugs, and this will go away if you stop the medication. If your liver test results (AST and ALT) are greater than 3 times normal, we stop your statin drug. If this is going to happen it usually does in the first three months you’re on the prescription, so you’ll have blood tests 12 weeks after you start your cholesterol medication and every 6 – 12 months after that.
  2. What about that scary muscle problem? It is scary, but it is also very rare. As rare as it is, rhabdomyolysis is what your doctor and pharmacist will warn you about. If your muscles start to ache or feel very weak (usually the muscles closest to your body, like the ones in your hips and shoulders), stop your medication and talk to your doctor. This is not a subtle ache—this is an impressive aching and weakness and you will know if it happens.
  3. Do they work? Yes, they work well—really well. Your LDL cholesterol (the “bad cholesterol”) will drop on average 40 – 60%, along with a nice drop in your triglycerides.
  4. Can I stop them once my LDL Cholesterol comes down? Patients often ask me this, and the answer is no. If you stop your statin drug your cholesterol will go back up in two months. It’s not like an antibiotic for strep throat where you treat it and it’s gone. You are on it for life.
  5. Are there any other good options for lowering my bad cholesterol (LDL)? Not really. Zetia (ezetimibe) has been a non-statin option. Zetia will lower LDL cholesterol by about 13% and is well tolerated—however, Zetia took a hit after the updated 2013 guidelines for treating high cholesterol were released. It’s expensive, and added to a statin it provides no known benefit in prevention of heart disease. There may be more options on the horizon though, in new injectable cholesterol medications Praluent and Repatha.
  6. Do I have to take it at night? No, you don’t have to take it at night. Blood levels of the statins are lower following evening doses compared with morning dosing, but LDL cholesterol reduction is the same regardless of the time of day the drug is administered.
  7. Do I have to take it on an empty stomach? No, the reduction of LDL cholesterol is similar whether you take your statin with or without food..
  8. What’s the deal with grapefruit juice? This is one difference among the statin drugs. Unlike atorvastatin (Lipitor) and simvastatin (Zocor), the enzyme that causese a problem with grapefruit juice does not metabolize Crestor (rosuvastatin). Grapefruit juice inhibits that enzyme, which inhibits the breakdown of your statin, which results in higher statin levels in your body. You can’t have grapefruit juice while on atorvastatin or simvastatin, but you can with Crestor.
  9. What about Coenzyme Q10? Statin drugs lower the level of CoQ10 in our body, but the effect of this is unknown. Studies have tested CoQ10 supplementation to prevent muscle problems from statins but it hasn’t been shown to be of any benefit. However, many patients still take it. It probably won’t hurt, but there’s no evidence that it helps, either.
  10. Are the statin drugs all the same? The easy answer is yes. Whether it’s atorvastatin, simvastatin, or Crestor, you can count on a 40 – 60% drop in LDL depending on dose. They are very different in cost because atorvastatin and simvastatin are generic and Crestor is still a brand-name drug only.

Dr O.

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