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Will Your Doctor Suggest a Statin?

by Jason Poquette, BPharm, R.Ph.

According to some interpretations of the latest recommendations issued just last month by the ACC (American College of Cardiology) and AHA (American Heart Association), doctors may be recommending statins more often in days to come.  These new guidelines were released Tuesday, November 12, and are already drawing sharp criticism.  What’s new in these recommendations is the shift in focus from merely looking at LDL (also known as “bad cholesterol”) numbers, to a total evaluation of the patient’s health and medical situation.  In other words, patients may be advised to begin therapy on the cholesterol-lowering statin medications even if their overall cholesterol numbers are not considered too high. 

So, what exactly are “statins”?  Statins are a family of prescription medications prescribed to lower our blood level of cholesterol and slow down the development of atherosclerosis which can cause strokes, heart attack and death.  They work by interfering with the production of cholesterol within our liver. We need cholesterol; but elevated levels have been associated with the buildup of plaques within the walls of our arteries.  Commonly prescribed statins include drugs like lovastatin, simvastatin and atorvastatin. These medications, taken appropriately, have been shown to significantly reduce the risk of cardiovascular disease.

But, like many families of medications, they do carry risks and side effects.  Common side effects include things like headache, nausea, diarrhea, and muscle pain or weakness.  Additionally, a study recently published in the Journal of Clinical Lipidology highlights the fact that drug interactions are frequently to blame for the side effects of statins.  Frequently used products like certain antibiotics, cardiovascular drugs and some psychotropic prescriptions can cause elevated blood levels of statins leading to an increased frequency of side effects.  Large amounts (> 1 liter) of grapefruit juice may also interact with certain statins. 

Some experts are concerned that the new guidelines will radically increase the number of patients taking statins and, although they have certain benefits for sure, may unnecessarily expose an excessive number of patients to potentially serious side effects.  Who, according to the new recommendations, should be taking a statin?  The following groups are now considered candidates:

  • Patients who already have heart disease (e.g. previous heart attack, stroke or arrhythmias)
  • Patients ages 40 to 75 with diabetes
  • Patients with very high LDL cholesterol (i.e. > 190mg/dl)
  • Patients with a calculated risk of developing heart disease in the next 10 years of 7.5% or greater

So what do patients need to know about the new statin guidelines and the concerns about side effects discussed in this article? 

First, the decision to begin treatment with a statin should be considered in the context of a comprehensive discussion with your physician about your health and risk for developing heart disease.  You and your doctor should be working together to discuss all the options available to lower your risk.

Secondly, being aware of the potential side effects of statins helps you to know when to call your doctor when starting a statin.  Mild side effects like headache and nausea may improve, and might be managed temporarily with OTC products if appropriate.  However, sudden and severe muscle aches should be reported immediately to your doctor to prevent potential complications which might become serious.

Thirdly, we all should be aware that a significant amount of our risk for heart disease can be due to lifestyle choices. Healthy diets and exercise are still the best medicine, and may be enough for many patients.

So, will your doctor suggest a statin?  Maybe.  But hopefully this article gives you a little background and helpful advice to chew on.

Jason Poquette, BPharm, R.Ph., is a practicing pharmacist who lives in Whitinsville. Hi columns comment on drugs and pharmaceutical issues in the news. He maintains the blog:  Readers are invited to submit questions.