Understanding Statins: How They Lower Your Cholesterol

Too much cholesterol can lead to excess plaque in arteries. Plaque is a buildup of cholesterol and fat that can block blood flow to your heart and other parts of your body. If plaque continues to accumulate in your arteries, it can do more than just make them narrow. Plaque buildup in your blood vessels can rupture, triggering a heart attack or stroke.

What is a Statin?

If you are struggling with high cholesterol and lifestyle modifications have not helped to reduce your numbers, your physician may prescribe a medication called a statin to lower your cholesterol into the normal range and reduce your risk of further health problems.

Statins help to decrease the "bad" cholesterol in your body. They block an enzyme the liver uses to make cholesterol, and they help your liver remove cholesterol already in the blood. Statin drugs lower your total and LDL cholesterol levels to make you less likely to have a heart attack or stroke.

“If you have high cholesterol, it is important to take steps to lower it. High cholesterol can cause serious health problems like heart disease and stroke.

Joseph Wiedermann, MD, Cardiologist at Catholic Health

What is a normal total cholesterol level?

There are two types of cholesterol: low-density lipoprotein (LDL, or “bad” cholesterol) and high-density lipoprotein (HDL, or “good” cholesterol). Statins can decrease your LDL by 50% or more. They also increase your HDL, which helps bring cholesterol to the liver for removal from the body.

A normal total cholesterol level is below 200 mg/dL. In the normal range:

HDL is above 60 mg/dL
LDL is below 100 mg/dL

Your cholesterol is considered high if your total cholesterol level is 240 mg/dL or higher. In this range:

HDL is below 40 mg/dL (men) or below 50 mg/dL (women)
LDL is above 160 mg/dL

Who should be taking a statin?

If diet and exercise haven't been effective, you may need medication to help lower your cholesterol. If you are between 40 and 75 years old, you may benefit from a statin if you:

Have diabetes and an LDL > 70
Have an LDL > 70 and high risk of heart disease
Use tobacco products
Have a BMI over 30
Have a family history of heart disease

Medication can also benefit people whose cholesterol cannot be lowered to a normal range with diet changes and physical activity.

What types of statins are commonly prescribed?

Your physician will prescribe the medication that best suits your individual condition and your health. There are several FDA-approved statins, including:

Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Lovastatin
Pitavastatin (Livalo)
Pravastatin
Rosuvastatin (Crestor)
Simvastatin (Zocor, Flolipid)

Your specific prescription also depends on several factors, including:

Age
Family history
Other medicines you are taking
Risk factors for heart disease and blood vessel disease
Sex
Your target cholesterol level

Statins have been proven to lower LDL cholesterol by as much as 50%. Taking a statin may reduce your risk of cardiovascular disease, strokes, or heart attacks.

How long do I need to take a statin?

“You typically have to take them for the rest of your life,” said Dr. Wiedermann. “Your body will always produce cholesterol, which will build up if you stop taking your medication.”

Physicians recommend taking the statin at the same time every day so you remember to take it. Most people take it before bed.

Your medication may not work as well if you skip or stop taking doses. Your body needs a certain amount of the medication at all times to be effective. If you miss a dose, do not take an extra one to make up for it. Take your next dose as usual.

What are the side effects of statins?

Statins are generally safe and effective for most people. However, some people may experience side effects including:

Digestive issues including diarrhea, nausea, and constipation
Dizziness
Headache
Interactions with other medicines
Joint or muscle aches
Increased blood sugar levels

Most people do not experience side effects. If you have side effects from one statin, your physician can prescribe another type of medication.

Can I manage cholesterol without statins?

Physicians do not recommend statins for everyone. Your physician may avoid prescribing them if you:

Are pregnant or nursing
Have an increased risk for myopathy, a condition that attacks the skeletal muscles
Have an underactive thyroid
Have had a previous allergic reaction to statins
Have liver problems
Have had side effects from taking statins or fibrates

What are PCSK9 inhibitors?

In some cases, if you don't see enough improvement on a statin or you can't tolerate the side effects, your physician may switch you to a PCSK9 inhibitor.

PCSK9 inhibitors are medications that lower LDL cholesterol by blocking a protein called PCSK9. This protein destroys special receptors in your liver that help your body remove LDL cholesterol. PCSK9 inhibitors have been shown to lower cholesterol levels by an average of 50% to 60%.

Research finds that these medicines are safe to take and have a low risk of side effects. The three types of PCSK9 inhibitors are Leqvio, Praluent, and Repatha.

PCSK9 inhibitors are administered through injections. Praluent and Repatha are given once every two to four weeks. The first and second doses for Leqvio are administered three months apart and after that, once every six months.

Lifestyle Changes May Help

“It may be possible to manage your cholesterol without medicine if you make significant lifestyle changes,” said Dr. Wiedermann. “Your physician will monitor if these changes have been effective at lowering your cholesterol."

Lifestyle changes may also help to lower your cholesterol. These may include:

Eating a heart-healthy diet low in red meat and saturated fat
Exercising regularly
Limiting alcohol intake
Losing weight
Maintaining a healthy weight
Quitting smoking and tobacco products

When deciding on a cholesterol medicine, speak with your physician about your treatment goals and the benefits and risks of each drug. When it comes to protecting your heart, personalization is your most powerful prescription.

Learn more about the advanced cardiology services at Catholic Health.