How Statins Work To Keep Your Heart Healthy

Health Conditions

How Statins Work To Keep Your Heart Healthy

Coronary Artery Disease.Diabetes.High Cholesterol
Man-Khoi Nguyen, PharmD, BCPS
By Man-Khoi Nguyen, PharmD, BCPS
Feb 17, 2020
Doctor using a stethoscope to hear the patient's heartbeat

According to 2016 and 2017 data, heart disease is the leading cause of death in the United States. The total number of deaths due to heart disease is close to 650,000 each year. In other words, a person dies every 37 seconds in the United States due to cardiovascular complications. But what is heart disease?

How to Understand Heart Disease

Heart disease comprises many different conditions that affect the heart. The most common condition is called coronary artery disease, which affects the arteries supplying blood to the heart. Coronary artery disease happens when plaque build ups, made from cholesterol and other substances, and deposits along the wall of the arteries. This makes it harder for the blood to flow through.

When a blood clot forms and gets clogged in these narrowed arteries, it can block the blood flow and can lead to severe complications, such as stroke or heart attack. A heart attack occurs when the blood flow leading to a heart muscle is blocked, causing that part of the heart muscle to die. 

One person suffers from a heart attack every 40 seconds in the United States. Alarmingly, one in five may suffer from a silent attack, which means the person may not even feel the effect as it happens.  Having high cholesterol puts you at a higher risk for heart disease.

Cholesterol is a waxy, fat-like substance. Under normal conditions, our liver can produce sufficient amounts of cholesterol for the body to function. However, people are more than likely to obtain a surplus of cholesterol from their diet.

What’s The Difference Between LDL and HDL?

LDL (low-density lipoprotein), commonly known as the “bad” cholesterol, has been shown to be the culprit in creating the arteries plaque buildup. HDL (high-density lipoprotein), the “good” cholesterol, has been shown to offer some protective effect against heart disease.

As high cholesterol is a “silent” disease, people do not show any symptoms until it is too late. It is important to get the cholesterol levels checked at least yearly, which can be done at an annual physical visit with your provider.

Luckily, a class of medication, commonly referred to as Statin, has been shown to effectively lower the risk of cardiovascular complications.   Statins work to reduce the cholesterol produced by the liver, lowering the total cholesterol level in the blood. Interestingly, statins aim at lowering the LDL cholesterol while also offering a potential boost in the HDL cholesterol.

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Not all statins are created equal.  Depending on the statin and its prescribed dose, a statin may be classified as low, moderate, or high in intensity. This refers to their expected ability to lower the LDL cholesterol, from about 30% to greater than 50% reduction.

Research has shown that statins may reduce the risk of heart attack by 25% or more, and it may also help patients with existing heart disease avoid cardiac procedures. Recent guidelines have supported the use of statins due to evidence of its benefits. In general, statins are recommended in patients identified as having a potentially high risk for cardiovascular complications:

  • Those with existing heart disease or prior cardiovascular complications
  • Those with extremely high cholesterol level (defined as LDL of 190 mg/dL or higher)
  • Those between the age of 40-75 with diabetes
  • Those between the age of 40-75 with a high 10-year cardiovascular risk

As commonly occurred with other medications, there are some common side effects associated with the statins.

Muscle-Related Symptoms when Taking Statins

To many people, including health care providers, muscle pain and cramps have been referred to as the most notorious side effects of statins. In reality, the risk of muscle injury due to this drug class is rare. 

Even though some studies have found that there is an observed increased risk of muscle symptoms in patients taking statins when compared with placebo, the observed 1.4% increase, at most, in incidence is considered negligible in clinical practice. In its 2018 statement, the American Heart Association (AHA) attributed the observation of the muscle-related symptoms to the “nocebo effect.” The organization believes that patients are more likely to blame statins for these side effects due to the negative warning from providers and the media.

However, it is always important to raise concerns with your provider if you notice any major muscle-related symptoms when you are taking a statin. Some of them include severe muscle pain even while at rest and persistent muscle ache lasting for weeks. Your provider may perform some blood tests to determine if you are indeed intolerant to the medication.

If you are worried about potential muscle pain, a supplement commonly found in your pharmacy may help reduce that risk. Cholesterol and coenzyme Q10 are made by the same pathway that the statins work against, so giving yourself a boost of Coenzyme Q10 may help lower the degree of muscle symptoms. Speak with your provider to see which dose of Coenzyme Q10 is recommended for you.

Otherwise, staying hydrated throughout the day will also help reduce the risk of muscle cramps. Interestingly enough, if you develop these symptoms when taking a statin, you may not experience the same symptoms with other agents within this class. Your provider and you may discuss and determine if an additional trial of other statins may be appropriate before declaring yourself intolerant to all statins.

Diabetes and Statin Therapy

In recent years, it has been a concern that statins may increase the risk of patients getting diabetes. The AHA recognized that there is only a minimal risk (0.2% per year) of developing diabetes while taking a statin.

However, this risk is largely seen in patients who are already at risk to have diabetes, including those with pre-diabetes or other conditions. Additionally, studies have shown mixed results on whether the risk can be attributed to statin therapy. Currently, it is recommended that the providers consider the risks and benefits of statin in patients who are at risk for developing diabetes. 

In these patients, other lifestyle changes, such as weight loss and exercise, are also recommended to help lower the risk of developing diabetes. It is also good to have regular follow-up visits with the providers so that they can monitor the blood sugar control.

Liver Injury Concerns with Statin Medications

Previously, animal studies have shown some potential liver injury as an associated side effect of statin therapy. This has prompted regular monitoring of liver function in the past. However, recent studies have found that these symptoms would unlikely to be caused by statins. Overall, the AHA concluded that the risk of statin causing concerning liver injury is extremely rare, with an incidence rate of about 0.001%.

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Of course, if you ever have any signs and symptoms associated with potential liver injury, let your provider know immediately. Some common signs and symptoms include yellow-colored skin and eyes, abdominal pain and swelling, dark urine color, and chronic fatigue.

All medications may come with side effects, it is important to discuss with your provider on the benefits and risk before starting on a new medication. As statins may help lower the risk of heart disease, check with your doctor if statin m

Man-Khoi Nguyen, PharmD, BCPS

Man-Khoi Nguyen, PharmD, BCPS

Man-Khoi Nguyen, PharmD, BCPS, is a board-certified pharmacotherapy specialist pharmacist. Man-Khoi serves as Pharmaceutical Data Analyst for RxSaver, in addition to working as a clinical pharmacist for a health plan taking care of patients in the primary care setting.

The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.

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