What you need to know about statinsPosted on: 17 October 2019 by Gareth Hargreaves
Statins are among the most widely prescribed drugs for countering LDL and HDL cholesterol levels and managing the conditions of people with cardiovascular disease. Dr Sarah Brewer reveals all you need to know about statins.
When first introduced, statins were prescribed to lower cholesterol levels. Now, they are also prescribed even to people whose cholesterol levels are normal, if you’re at high risk of developing a heart attack or stroke - for example, if you have diabetes or a strong family history of cardiovascular disease. Statins are prescribed to prevent a recurrent heart attack or stroke, and to those with peripheral arterial disease to help slow its progression. Some research also supports the use or statins in people over the age of 65 to help reduce the risk of a stroke.
What are they?
Statins are a group of drugs used to lower levels of ‘bad’ LDL-cholesterol in the blood, helping to reduce the risk of coronary heart disease and stroke. They work by blocking the action of an enzyme (HMG-CoA reductase) in the liver, so the amount of cholesterol you make is reduced. Those available in the UK are: atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin. Combinations of simvastatin with ezetimibe or with fenofibrate are also available.
Are they suitable for everyone?
Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive) as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects foetal development.
Statins should only be used with caution in the elderly, those with a high alcohol intake or history of liver disease, if you have an underactive thyroid gland, kidney or muscle problems.
Before starting statins, doctors are advised to check your liver, kidney and thyroid function as well as your cholesterol balance and triglyceride levels. If you are at high risk of diabetes (eg obese, or family history) you will also have your blood glucose and HbA1c (a measure of longer-term glucose control) measured.
What you need to know about side effects?
Statins are generally considered safe but, like all medicines, they can have side effects. Everyone responds differently, but statin side effects that are classed as common or very common include: lack of energy, constipation, diarrhoea, dizziness, flatulence, stomach or intestinal discomfort, headache, muscle aches, nausea, sleep disorders and developing a low platelet count (thrombocytopenia).[i]
Side effects classed as rare or very rare include muscle weakness, peripheral neuropathy (pain) and tendinopathy (painful tendons).
Other recognised side effects whose frequency is unknown include depression, triggering diabetes in those at risk, and interstitial lung disease.
Tell your doctor if you: develop symptoms such as shortness of breath, cough and weight loss, unexplained muscle pain, tenderness, or weakness while taking statins.
Can I buy statins over the counter and if so how to choose?
Low-dose statins are available at some pharmacies without a prescription, but it is better to have a statin prescribed by your doctor who can monitor how you respond.
Statins lower coenzyme Q10 levels
As well as blocking production of cholesterol in the liver, statins also block the production of an important cell nutrient called coenzyme Q10.[ii] Taking a statin can halve your circulating blood levels of co-enzyme Q10 within 2 to 4 weeks.[iii] Coenzyme Q10 is needed for energy production in cells, especially muscle cells. This may explain why one in ten people taking a statin drug experience some form of muscle-related side effects.
Adding in a coenzyme Q10 supplement (eg Healthspan’s Ubiquinol 100mg per day, 60 tablets £34.95)) may help to reduce statin side effects such as fatigue or muscle aches so you can continue to take your statin medication. Taking coenzyme Q10 does not affect the cholesterol-lowering action of statin drugs.[iv]
The heart has the hardest working muscle fibres in your body and taking statins has been associated with weakening of heart muscle to increase the risk of heart pump failure.[v] This is controversial, however, as statins are in fact prescribed to help treat heart failure in some patients. [vi]
In a recent study, involving 142 patients on statins who developed heart failure with no obvious cause (and therefore possibly linked to the statins) cardiologists stopped their statins and treated them with coenzyme Q10 (ubiquinol 300mg per day). The patients were followed for an average of 2.8 years and significant improvement in cardiac function were seen, with significant numbers returning to normal heart function. Statin-attributable symptoms including fatigue, muscle weakness, myalgias, memory loss, and peripheral neuropathy also improved. The researchers concluded that patients on long-term statin therapy who develop statin-associated cardiomyopathy improved on stopping the statin and taking CoQ10 supplements.[vii]
Statins lower vitamin D levels
Vitamin D3 is made in the skin when ultra-violet rays interact with a precursor called 7-dehydrocholesterol. As its name suggests, this is derived from cholesterol. As statins significantly reduce your cholesterol production, this precursor is in short supply. As a result, people taking a statin are more likely to be deficient in vitamin D, one symptom of which is muscle pain – a common side effect of statin medication.[viii]
A study involving 134 people who were intolerant of statins due to muscle pains, and who had low vitamin D levels, were given high dose vitamin D supplements to bring their blood levels back up to normal. When rechallenged with a statin while still taking vitamin D supplements, over 88% were able to tolerate the statin for six months without a recurrence of their pain at six months. After two years, 95% were still able to tolerate the statin while taking vitamin D supplements. [ix]
Vitamin D helps to regulate calcium and improves blood pressure control. Research from 19 studies, involving almost 66,000 people showed that people with the lowest vitamin D levels were 52% more likely to have cardiovascular disease than those with the highest blood levels, and more likely to have a fatal heart attack.[x]
About the author
Dr Sarah Brewer, is a registered doctor, a registered nutritionist and she is the medical director at Healthspan as well as being a respected author, columnist and health writer.
[ii] Passi S et al. BioFactors, 2003.18:113-124
[iii] Rundek T et al. Arch Neurol, 2004. 61(6):889-92
[iv] Bargossi AM et al. Molecular Aspects of Medicine, 1994. 15S:s187-93
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