Statins are a class of drugs that lower blood cholesterol levels.  They accomplish this by reducing the amount of cholesterol that the liver produces, and also by increasing the amount of low-density lipoprotein receptors, which clear LDL from the body. Statins have been used in humans since the 1980s, with Lovastatin being the first to market in 1987. They are prescribed for the primary and secondary prevention of Cardiovascular Disease (CVD). 

The goal of primary prevention is to prevent the onset of a disease, compared to secondary prevention, which aims at stopping the progress of a disease before it develops completely.  Statins generally reduce the risk of heart disease and stroke by 1% for each percentage of LDL-C lowered. High-intensity statins reduce LDL levels by 50% or more, and moderate regiments reduce LDL levels by 30% or more.

Importance of Statins:

Statins are the only drug with significant data that show a decrease in primary and secondary Atherosclerotic cardiovascular (ASCVD)  events. This is when plaque accumulates on artery walls. The accumulation of plaque then leads to reduced blood flow in arteries to various parts of the body and can cause chest pain (angina), stroke, intermittent claudication (pain in legs when walking), or even death.

Common statins:

• Lipitor
• Crestor
• Zocor
• Mevacor
• Lescol

This week we talked with Dr. Brett Hiendlmayr, an interventional cardiologist who specializes in structural heart disease and high-risk coronary interventions. He currently works at Idaho Heart Institute. 

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What are the common side effects of statins?

Dr. Hiendlmayr: The most common side effects are muscle aches, which can be anywhere in the body, but is most commonly seen in the legs. The pain is generally mild to moderate but can be severe enough to require discontinuation. The liver can also be affected. The damage to the liver is most often transient and can be detected by a blood test when suspected. There are no current recommendations for routine blood tests when on statin therapy. 

What are the common differences between statins? 

Dr. Hiendlmayr: The main difference between statins is the potency and the price. If someone has coronary artery disease, previously had a stroke, or has a high risk of cardiovascular disease, they would be given a high-intensity statin. Lipitor and Crestor are two of the most potent statins available. 

What therapies are common in conjunction with statins?

Dr. Hiendlmayr: Diet and exercise are important, especially for those who are overweight or obese. Other medications such as ezetimibe (Zetia) can be prescribed to those who are at a high risk of CVD and do not reach their goals of lowering lipid levels with statins alone. There also is a new class of medications called PCSK9 inhibitors, which stands for Proprotein Convertase Subtilisin/ Kexin Type 9. They are an injectable drug that is taken once every other week and have been shown to significantly reduce LDL levels when taken with a statin. 

What role does cholesterol play in Cardiovascular disease?

Dr. Hiendlmayr: Cholesterol can enter the blood vessel walls and form deposits that can cause narrowing of heart arteries which cause events like a heart attack or stroke. Tobacco use and diabetes can cause more inflammation and more depositing of cholesterol on blood vessel walls which cause those events like heart attack, stroke, etc. 

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For additional information, the American Heart Association Cholesterol Management Guide may be helpful.