Statins revolutionized treatment for high cholesterol in the 1980s. Today, there are several types of statins that may help manage your cholesterol levels when heart-healthy lifestyle changes aren’t enough. Sometimes, the first statin your doctor prescribes might not be the right fit. In this case, you might try a second-line statin.
“If a patient's been prescribed a statin and they're not reaching their targets, there are a couple of things that we want to do,” says Lawrence Phillips, MD, Cardiologist at NYU Langone Health. “Do we need to go up on the medication dose or change to a different medication within the same class? Or do we need to add another medication on board to get them to their goal?”
What are statins?
Statins serve two main functions: They decrease your body’s own production of cholesterol, and they help remove cholesterol in the liver. These two functions combined help reduce LDL (bad) cholesterol levels to safer levels, thus reducing your risk of heart attack and stroke. They also have anti-inflammatory and anti-oxidant effects. Patients tend to tolerate statin medicines well and see promising results, so statins are often the first-line treatment against high cholesterol.
Second-line statins
“Second-line statin” is just a fancy way of saying the first statin you tried wasn’t the right fit. It means the first-line treatment either didn’t reduce cholesterol levels enough, despite you taking it as prescribed and making lifestyle changes.
“Another time where we'll change a patient from one statin to another is when they're having side effects, such as muscle aches. We'd like to try two statins to make sure that we're able to tolerate at least one of them before moving on to other classes of medications,” says Dr. Phillips.
Getting to know your new statin
You might be thinking, If one statin didn't work for me, why would I try another? It’s important to remember that not all statins are the same. “Within the class of medications of statins, there's a difference enough in their pathway that some patients are able to tolerate some and not others,” says Dr. Phillips.
As a result, you need to understand your new statin well—and not assume that it’s going to be the same as your first statin. When you’re getting a second-line statin, consider asking your doctor the following questions:
Why do you recommend this statin?
How is this different from my first statin?
What side effects should I expect?
How long should I expect to take this statin?
How will I know if this statin is working?
What are my options if this second-line statin doesn’t work either?
“When a patient is not able to tolerate one medication and expresses frustration, the first thing to do is to reassure them that this is very common and that we have many different options that we can use in medications, both within the statin class and others, but in the great majority of patients, if we work together, we can reach our target,” says Dr. Phillips.
Lawrence Phillips, MD, is a Cardiologist at NYU Langone Health.
References
Centers for Disease Control and Prevention. (2024). High cholesterol facts.
Endo, A. (2010). A historical perspective on the discovery of statins. Proceedings of the Japan Academy, Series B: Physical and Biological Sciences;86(5):484-93.
Last, A, et al. Hyperlipidemia: Drugs for Cardiovascular Risk Reduction in Adults. American Family Physician;95(2):78-87.
Rosenson, R.S., et al. (2024). Patient education: high cholesterol and lipid treatment options (beyond the basics). UptoDate.
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