About 86 million adults in the United States have high cholesterol, a condition that increases the risk for heart disease and stroke. Despite this high number, only 35% of American adults who could benefit from cholesterol-lowering medication actually take it.
Although some medications can help, the most common class of cholesterol-lowering medications are statins. However, you’re not alone if you’re not sure how they work, when to take them and whether there are potential side effects you should be concerned about. So what’s the deal with statins and how safe are they? Cardiologists break it down.
How exactly do statins work?
The main function of statins is to lower your cholesterol. Statins work in the liver to block the pathway that makes cholesterol, Dr. Blair Suter, a cardiologist at Ohio State University Wexner Medical Center, to Yahoo Life.
Your liver responds to statins by taking up cholesterol particles in the blood more easily, leaving less cholesterol in your blood, Dr. Yu-Ming Ni, cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. , tells Yahoo Life. (Higher blood cholesterol levels can damage your arteries, increasing the risk of heart attack or stroke, he explains.)
The more cholesterol you have in your blood, the faster it gets incorporated into plaques on the walls of blood vessels, Dr. Alexander C. Fanaroff, assistant professor of medicine in the division of cardiovascular medicine at the University of Pennsylvania, to Yahoo Life. If the plaques grow too large, they can block blood flow to the heart or brain, causing a heart attack or stroke, he says. Therefore, lowering cholesterol with statins may help reduce the risk of heart attack or stroke.
There’s also some data that says statins reduce inflammation, Ni says, noting that it can also help lower your risk of heart attacks or strokes.
Who needs statins?
The US Preventive Services Task Force (USPSTF), American College of Cardiology (ACC) and American Heart Association (AHA) state that the following groups of people may benefit from statins:
People with one or more cardiovascular disease risk factors and a higher 10-year risk of having a heart attack. That includes people with diabetes, high cholesterol or high blood pressure, as well as people who smoke.
People with cardiovascular disease. These are patients with heart disease associated with hardened arteries, including those who have had a heart attack or stroke from blood vessel blockages, mini-strokes, peripheral artery disease or surgery to open or replace them the coronary arteries.
People with high LDL (bad) cholesterol. This includes adults with LDL cholesterol levels of 190 mg/dL or higher.
Adults with both diabetes and high cholesterol. This includes adults 40 to 75 with diabetes and an LDL cholesterol level between 70 and 189 mg/dL.
Statins reduce the risk of heart attack, stroke or cardiovascular death by about 30%, Fanaroff said. This means that a person’s 10-year risk would be 7.5% if they weren’t taking statins and the drug would reduce that risk to about 5%. If a person’s risk is higher, such as 25%, statins reduce that risk to about 17%, Fanaroff points out.
Are statins safe?
While doctors agree that statins are safe and well tolerated by most people, some patients are concerned about taking them. People may be concerned about starting statins because of potential side effects related to liver, muscle and cognitive impairment, Suter said.
These often stem from a 2012 warning from the Food and Drug Administration, which stated that people using statins reported dealing with a range of health issues, including:
Short-term memory loss and confusion that go away when people stop using the drug
Increases in blood sugar levels
In rare cases, serious liver problems
But, again, the data is mixed. Research is conflicting and controversial about all of these side effects, Suter said. A 2021 study published in the Journal of the American College of Cardiology analyzed data on statin use in 18,446 people age 65 and older. The researchers found that people who took statins were no more likely than people who did not use the drugs to develop dementia during the five-year study period. There were also no differences in memory, language and executive function.
Another study, this one published in the journal Scientific Reports, analyzed data from 55,114 people taking statins and compared them with 245,731 people not on the drugs. Participants were measured for reaction time, working memory and fluid intelligence (the ability to reason and think flexibly) at the start of the study, as well as during two follow-ups within five to 10 years. The researchers found that older people who took statins had better reaction times and fluid intelligence, while younger people had improvements in fluid intelligence but decreased working memory. As a result, the researchers concluded that the effect of statins may vary by age.
For blood sugar levels, research shows that in patients at high risk for atherosclerotic disease, the hardening of the arteries caused by plaque buildup, the benefits of statin use are greater than on the risk of new-onset diabetes. That benefit-risk ratio is less clear and should be discussed with a health care provider when it comes to patients who do not have diabetes and have either zero or one risk factor for atherosclerotic disease.
As for liver disease, a 2023 study of more than 1.7 million people published in JAMA Network Open found that regular use of statins was associated with a 15% lower risk of developing the disease. in the liver and a 28% lower risk of dying from a liver-related issue compared to people who do not take drugs. There is also a 74% reduced risk of developing liver cancer in people who regularly use statins.
What are the possible side effects of statins?
Although there are more serious potential side effects that are still being studied, there are some minor issues that statin users may experience.
The most common side effect of statins is muscle pain, says Dr. Samuel Kim, preventive cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center, to Yahoo Life. Kim says this is more common in clinical practice than large clinical trials suggest. However, Kim said side effects are likely to get better with time and by adjusting dosages. Side effects can also include fatigue and increased blood sugar, but these are less common, he says.
Even for patients with side effects, when they lower the statin dose or try the drug again after a temporary break, they often tolerate the drug, Kim said.
Why aren’t more doctors prescribing them?
A study published in the Annals of Internal Medicine in early December analyzed National Health and Nutrition Examination Survey data from 1999 to 2018 and found that while the use of statins to prevent cardiovascular issues increased in at the time, only 35% of people eligible for the drugs actually used them.
The researchers theorized that many doctors don’t have the time to do the necessary multistep risk calculations for prescribing statins, so they don’t prescribe the drugs. When you give primary care providers hypothetical patient situations and ask whether these patients should be prescribed statins, primary care providers tend to stick to the guidelines and prescribe statins in eligible people, Fanaroff said. To me, this indicates that more doctors are not prescribing statins because they are too busy with short clinic appointments to attend to all the patient’s needs, and may sacrifice preventive care to take care of the more urgent ones. to remember
Fanaroff stressed that this is not a case of doctors being lazy. In one study, researchers showed that it would take 26.7 hours for primary care providers to take care of all the acute and preventive needs of the patients they see in one day, which is clearly impossible, he says. Research from our group and others shows the promise of involving other members of the health care team, such as nurses and pharmacists, to help prescribe statins to appropriate people.
But Ni says the issue is more complicated than the available time. There is an abundance of misinformation about statins, he says. I have heard patients complain that cholesterol is not important for reducing heart disease, that statins damage the liver and cause dementia and that even doctors are in cahoots with pharmaceutical companies to make a profit. money on statins none of this is true, he said.
Kim agreed. Statins have proven to be a very safe drug and are well tolerated in most of the population, he says. There should be a mutual discussion between a provider and patient surrounding the risks and benefits. Statins remain underused.
Ni stressed that statins are also cheap. They are one of the most cost-effective treatments we have for fighting No. 1 killer in America: heart disease, he says.
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