All About Statins

Statins are the drugs prescribed to help protect healthy, but high-risk people from heart disease and prevent repeated problems in people who have already had a heart attack or stroke. There has been considerable media coverage of statins recently, so here are answers to some of the most frequently asked questions:

How do statins work?

Statins reduce the amount of cholesterol produced in the body.

Our cells naturally make cholesterol to maintain their membranes and also use it to make essential compounds such as hormones. Liver cells are the most active cholesterol 'factories'. However, too much cholesterol in the blood can increase your risk of getting heart and circulatory disease. 

Statins reduce the amount of cholesterol produced by cells all over our body. This forces the cells to get their supply by removing cholesterol from the bloodstream, which lowers the blood cholesterol level. 

What are the benefits of taking statins?

Statins help reduce cholesterol and can help to reduce the risk of a heart attack.

Statins reduce your level of a type of cholesterol called low-density lipoprotein or LDL. this is commonly called bad cholesterol because high levels of it can lead to the build up of fat in your arteries that can lead to coronary heart disease.

Larger clinical trials, involving many thousands of people have shown that lowering blood cholesterol reduces your risk of heart disease, especially heart attacks.

A small minority of doctors disagree with the evidence but their personal views are at odds with virtually all informed medical opinion.

When did the statin research trials start?

The two watershed studies showing statins had significant benefits were completed in the mid 1990s - the Scandinavian 4S trial, and Scottish WOSCOPS trial.

I have heard that statins can have serious side effects? Should I be worried about taking them?

Like all medicines, statins can have some side effects. The risks of statins have been overplayed recently in the media. Statin side effects are usually mild, easily recognizable, reversible and very rarely dangerous. Statins are among the safest of drugs and the most studied medicine available today.

The risks that do exist have been discovered through rigorous clinical trials, and through the international 'yellow card system', which allows doctors to report individual cases of serious side-effects caused by prescription medicines.

Because statins work mainly by targeting liver cells, the liver's function can sometimes be affected. This will be tested before you begin taking statins, and then reviewed a few months later. If your liver function is affected, your doctor will probably prescribe a different stain. In rare cases the liver cannot tolerate any statin.

Some people may experience unpleasant muscle pains when taking statins. This is normally short-lived, but if it persists you should tell your GP. The doctor can deal with this very easily by reducing the dose of the statin or switching to a different one.

Very rarely the muscle leaks proteins which can build up in the kidney and cause a serious condition called rhabdomyolysis. It is extremely rare and affects about one in 100,000 patients; most people recover well after treatment.

Will taking statins put me at risk of Parkinson's disease or Alzheimers?

There is no evidence that statins cause or prevent these conditions. Associations between diseases and medicines or foods often turn out to be a coincidental link.

Controlled trials comparing people who take a medicine with those who take a placebo provide the most trustworthy answers about the risks and benefits of any drug.

Can I lower my cholesterol level with a low fat diet?

A balanced diet is one of the best ways to prevent ill health. However, on it's own, dietary changes are not usually very effective in significantly lowering cholesterol.

What are the differences between statins?

Statins all work in the same way but different types have different chemical structures. These subtle variations may mean that your body might tolerate one type of statin better than another.

The design of statins has evolved, so more recent preparations (eg. atorvastatin and rosuvastatin) are more potent than older types of statin (eg. simvastatin). Many people do not require a more potent statin to reach their treatment target cholesterol level.

Does it matter which statin I am prescribed?

Your doctor will choose the best statin and dose for you, depending on your medical history and your target cholesterol level.

Simvastatin is now "off-patent" which has made it cheaper than other statins, prompting doctors to review if their patients could swap from more expensive types. This is sensible because simvastatin is adequate for most people.

However, patients should have a blood cholesterol test before and after the change of statin to ensure that simvastatin is working for them.

If I start taking statins does it mean that I am on them for life?

Unfortunately, your body doesn't learn to stop producing cholesterol. It will go back up within weeks of coming off statins, so you will have to keep taking your prescription to maintain the benefits.

Who should take over the counter statins?

Low-dose statins are available at pharmacies. These are not a substitute for prescribed statins, so if you are at high risk of heart disease, your doctor should provide you with a prescription and monitor their effects.

When should I take my statin?

The best time to take statins is before bed, because more cholesterol is produced while you sleep. However the most important thing with all medicines is to take them regularly, as prescribed – if bedtime is not convenient for you, don’t worry.

Do I need to avoid any foods or other drugs when taking statins?

Other drugs may interfere with statins, so if you experience symptoms after changing or getting a new medicine you should report it to your doctor. Subtle changes to your prescription may well fix it.

Grapefruits – whole and juiced – contain a compound that blocks the breakdown of simvastatin and should be avoided if you are taking this type of statin.

Are statins effective and safe for women?

The evidence that we have so far indicates that statins are equally effective in both genders. Women who are pregnant or who are planning a pregnancy in the near future should not take statins. Women you are already taking a statin and are planning a pregnancy, you should discuss it with their doctor first.

Do I have a choice in taking statins?

Everyone has a choice. No-one will force you to take a statin if you don't want to. However if you have already had a heart attack, or are at high risk of having one, then taking a statin will definitely reduce your risk of having a further or a first heart attack.

Most people who are offered statins have at least a one in five chance of having a heart attack in the next ten years. This risk is substantially reduced by taking a statin and the statistic needs to be set against a one in 10,000 chance of having a dangerous side effect from statins over the same period.

For every patient who reports a bad experience on a statin, there are hundreds more for whom a heart attack has been prevented - they are the silent majority who never contact the media.

Where can I find further information about statins?

For more information please download our Medicines for the Heart booklet.

If you have any further questions about statins, please call our Heart Help Line on
08450 70 80 70 (local rate number). Lines are open 9am to 5pm Monday, Tuesday and Friday and 8am to 6pm Wednesday and Thursday.

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