Statins and statin combinations for high cholesterol

Examples

Statins

Statin combinations

How It Works

Statins block an enzyme the body needs to produce cholesterol. As a result, LDL ("bad") cholesterol levels in the blood go down, thereby lowering total blood cholesterol levels.

Statins may be taken alone or taken with other cholesterol medicines such as fibric acid derivatives, bile acid sequestrants, or nicotinic acid. Statins may also be combined with other types of medicines into one drug. For example, Vytorin is a combination medicine that lowers cholesterol in two ways: with a statin, which blocks the production of cholesterol in the liver; and with ezetimibe, which reduces the amount of cholesterol absorbed by the intestines.

Why It Is Used

Statins are used to lower LDL cholesterol. Statins have been shown to lower the risk of heart attack, stroke, and death in people who are at high risk of a heart attack or stroke.¹

How Well It Works

Studies show that statins lower the risk of heart attack, stroke, and death in people who have taken these medicines to lower their cholesterol.

• Studies show that intensive cholesterol-lowering therapy decreases the progression of coronary artery disease (CAD), compared with standard treatment.^{2, 3} In the PROVE IT study, people who recently had episodes of unstable angina or heart attacks received higher-than-standard doses of cholesterol-lowering drugs and had fewer subsequent heart attacks and strokes, and there were fewer deaths. This large study suggests that intensive statin therapy could save lives. The U.S. National Cholesterol Education Panel guidelines include more intensive treatment with statins as an option for people who are at moderate to high risk of heart attack.⁴
• A review of large clinical studies showed that statins may lower the risk of stroke in people who are at high risk of a heart attack or stroke.¹
• LDL can be reduced by 18% to 55%.⁵ The newer, more potent statins can reduce LDL levels even further. These statins include atorvastatin (Caduet, Lipitor) and simvastatin (Zocor).
• HDL can be increased by 5% to 15%.⁵
• Triglycerides can be reduced by 7% to 30%.⁵ The newer, more potent statins may lower triglyceride levels even more.
• Two studies show that intensive statin treatment also lowers levels of C-reactive protein (CRP), a biochemical marker associated with an increased risk of CAD and heart attack. Lowering CRP along with LDL significantly reduces heart attack and death in those who have had a previous heart attack or unstable angina.^{6, 7}

Side Effects

Most people do not have side effects with statins. But possible side effects include:

• Fatigue.
• Upset stomach.
• Gas.
• Constipation.
• Stomach pain or cramps.
• Minor muscle aches (not severe pain).
• Severe muscle pain (not common). Severe muscle pain can be a sign of a very serious side effect. Immediately report to your doctor any severe muscle pain, weakness, or brown urine. Your doctor may want to do a blood test. Muscle pain or weakness can be a sign of a severe muscle reaction (rhabdomyolysis) and should be evaluated by your doctor.
• Slight rise in liver enzymes called transaminases. Most of the time you do not need to stop taking the statin, unless the enzymes rise 3 or more times their normal levels. Regular blood tests are needed to check liver function while taking statins.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

These drugs do not cause side effects for most people who take them.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking a statin medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.⁸

Studies are focusing on combinations of statins and other medicines, such as nicotinic acids or fibric acid derivatives. These combination medicines are useful for lowering LDL and triglyceride levels. Statin and nicotinic acid combinations, such as the combination drug with niacin and lovastatin (Advicor), may also raise beneficial HDL levels in people who are at risk for CAD because of low HDL.^{9, 10}

Some medicines can cause harm when taken with other medicines. People who are taking combination statin medicines should tell their doctors if they are taking other medicines to treat high cholesterol or triglycerides. Also, tell your doctor if you are taking antibiotics or antifungal drugs.

The side effects of statin medicines are more likely when higher doses are used.

Regular blood tests to check liver function are recommended, but the frequency of testing may decrease over time. People who are taking high doses of statins, though, should be checked more frequently. People who have liver disease should talk to their doctors before taking these medicines.

People who are using statins should not take large amounts of niacin (a vitamin supplement) without telling their doctors.

Women who are pregnant or breast-feeding and anyone younger than 18 should not take statins.

Tell your doctor about all the medicines you are taking before using any medicine for the first time.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

1. Gami A (2007). Secondary prevention of ischaemic cardiac events, search date July 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. Cannon CP, et al. (2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495-1504.

3. Nissen SE, et al. (2004). Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. JAMA, 291(9): 1071-1080.

4. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227-239. [Erratum in Circulation, 110(6): 763.]

5. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486-2497.

6. Nissen SE, et al. (2005). Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. New England Journal of Medicine, 352(1): 29-38.

7. Ridker PM, et al. (2005). C-reactive protein levels and outcomes after statin therapy. New England Journal of Medicine, 352(1): 20-28.

8. Pasternak RC, et al. (2002). ACC/AHA/NHLBI advisory on the use and safety of statins. Circulation, 106(8): 1024-1028.

9. Grundy SM (2001). United States cholesterol guidelines 2001: Expanded scope of intensive low-density lipoprotein-lowering therapy. American Journal of Cardiology, 88(7B): 23J-27J.

10. Sacks FM (2001). The relative role of low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in coronary artery disease: Evidence from large-scale statin and fibrate trials. American Journal of Cardiology, 88(12A): 14N-18N.

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