How This Helps

Statins are usually the most common medications used to lower your cholesterol levels. Statins successfully lower the cholesterol levels in the body by blocking the very substance your body needs to manufacture cholesterol. However, reducing cholesterol levels is not the only function of statins. These drugs are also known to lower the risk of stroke and cardiovascular disease. It is first essential to know how do statins work to appreciate the benefits - and side effects - of statins. Let's take a closer look.

What are statins?

On September 1, 1987, lovastatin was the first statin to be approved in the USA by the FDA (Food and Drug Administration). Statins were considered a wonder drug to stop heart attacks and stroke due to high cholesterol. They are a type of drug that is designed to help block the action of a particular liver enzyme that helps in the manufacturing of cholesterol. Statins are usually the first stage of treatment doctors prescribe for lowering levels of blood cholesterol. There are several types of commercially available statins, including:

• Simvastatin[1]

• Mevastatin[2]

• Lovastatin[3]

• Atorvastatin[4]

• Fluvastatin[5]

• Rosuvastatin[6]

There are many others, but rosuvastatin and atorvastatin are the most powerful, and fluvastatin is said to be the least powerful drug.[7, 8]

In some cases, a statin drug can be combined with a heart medication to reduce the risk of heart disease. Some examples of this include simvastatin with ezetimibe and atorvastatin with amlodipine.[9, 10]

Now that we know what statins are, let us take a look at how do statins work.

See: How long does it take to reduce cholesterol

How do statins work to reduce cholesterol?

Statins are specially designed for people who have high cholesterol levels or are at a high risk of developing cardiovascular disease.[11] 

Statins work in two major ways to lower the levels of blood cholesterol. They are:

• Statins primarily work by stopping the very process that manufactures cholesterol in the body. Statins prevent the production of an enzyme known as HMG-CoA reductase. This enzyme controls the production of cholesterol in the liver. Statins slow down the entire process of cholesterol production by blocking the production of this enzyme. Decreased production of the liver enzyme helps reduce the total amount of cholesterol present in the bloodstream. [12] 

• The other way statins work is by reabsorbing the existing cholesterol. Your body needs cholesterol for performing many functions such as digestion of food, manufacturing hormones, absorbing vitamin D, and many others. So if statins were to reduce the level of cholesterol beyond a certain level, then your body would not be able to carry out many vital functions. Consequently, the body reabsorbs the cholesterol that has accumulated in the form of plaques containing the bad 'LDL' cholesterol in the blood vessels.[13]

See: Acute onset and worsening of diabetes concurrent with administration of statins.

Statins side effects

Are there any Side Effects of Statins?

It's not simply enough to only understand how do statins work. Since every medication has some side effects, it is necessary to understand if there are any side effects of taking statins.

In general, statins are considered to be safe for everyone, and most people do not experience any noticeable side effects from these drugs. However, there are several known side effects of using statins, especially if you already have some risk factors. While some of these side effects are common for all the statins, there are certain statins that have some unique side effects as well. 

Let us first look at the side effects that are common to all the statins. 

- Muscle Pain

Muscle pain is the most commonly experienced side effect associated with statins. Studies have found that intolerance of statin drugs is usually experienced as muscle-related discomfort. Anywhere between one to ten percent of muscle symptoms are often related to statin use.[14]

There is no doubt that muscle pain can lead to a lot of disruptions in your life. However, if you also have any of these other accompanying symptoms, then you should immediately call your doctor:

• Tiredness

• Fever

• Dark urine

• Unusual muscle cramps or pain

• Diarrhea

These symptoms are commonly associated with a condition known as rhabdomyolysis. Rhabdomyolysis is a severe condition that leads to muscle breakdown, which can cause problems with your kidneys.[15] 

Other Rare Side Effects 

Some other rare side effects that may be common to all statins include:

Confusion or memory loss

• Liver or kidney damage

• Increased levels of blood sugar, leading to diabetes

Bloody or dark urine, or experiencing pain in the chest or upper abdomen, should be considered as signs of severe liver and kidney disorders. If you experience such symptoms while taking a statin, then you should consult your doctor without delay. 

Some side effects that are believed to be limited to specific statins include:

•        Atorvastatin: The most common side effect of this statin is a headache and runny or stuffy nose

•        Simvastatin: When simvastatin is taken at high doses, it is more likely to cause muscle pain as compared to the other statins. The other side effects of this statin include having an irregular or fast heartbeat and feeling dizzy.

•        Fluvastatin: This statin is usually prescribed as an alternative statin for those who have experienced muscle pain while taking the other statins. Side effects of fluvastatin are diarrhea, vomiting, joint pain, trouble sleeping, or feeling unusually tired. 

- Statins are also known to impair memory. A study found that the regular use of statins, especially atorvastatin and pravastatin, leads to a decreased performance of working memory and recognition.[16] 

Keep in mind that side effects are possible while taking any medication. However, you are more likely to experience side effects if you:

• Are female

• Already have a liver or kidney condition

• Are 65 years or older

• Have a small body frame

• Are on more than one medication for lowering cholesterol

• Drink a lot of alcohol

See: High Cholesterol One-Day Sample Diet Plan

Can you reduce cholesterol naturally?

Other ways to reduce cholesterol

When we discuss statins, we also need to discuss a little bit about cholesterol. Cholesterol refers to one of two types.

a) First, there's blood cholesterol, which is mostly coming from the liver. The liver produces cholesterol as our bodies need it for all types of reasons. Cholesterol helps our cells do their jobs. Additionally, it is an essential part of many hormones. We wouldn't exist without blood glucose, but then again, neither would heart disease. There is cholesterol in your blood (blood, or serum, cholesterol), and cholesterol that you consume (dietary cholesterol). The important point is that our liver produces all the cholesterol we need.

b) The second type of cholesterol is the cholesterol that comes from the diet. This is the cholesterol we eat. Big sources include egg yolks, organ meats such as liver, and shrimp. If we consume too much dietary cholesterol, we can increase our blood glucose marginally, but what actually sends our blood glucose soaring are foods containing saturated fats and trans-fats. Foods full of saturated fat include butter, cheese, red meat, cream, whole milk, palm oil, and coconut oil. Foods with trans fats contain whatever foods have partially hydrogenated oils in its ingredient list, such as many cakes, pies, biscuits, donuts, cookies, and some margarine one would typically buy in stores.


Lifestyle Changes To Reduce Cholesterol Naturally

To improve our blood glucose levels, doctors frequently prescribe lifestyle changes centered on three key rules:

- Consume a lot less saturated and trans fat, lose weight and consume more foods that truly reduce blood cholesterol. They're foods rich in soluble fiber such as beans, barley, berries, yams, oats, brussels sprouts, and several other produce.


See: Functional medicine for Heart Disease

Summary

Statins are among the most commonly prescribed cholesterol-lowering drugs. If you have high levels of bad 'LDL' cholesterol, then your doctor is likely to prescribe this class of drugs to bring down your cholesterol and also to reduce the risk of heart disease. Along with taking the prescribed course of statins, you should also be following a healthy lifestyle, such as having a healthy diet and exercising regularly. Many times simple lifestyle modifications are also enough to bring down your cholesterol. Now that you are aware of how do statins work, if you have high cholesterol levels, then you should enquire from your doctor about whether taking statins can help in reducing your cholesterol. 

See: Herbs to lower high blood pressure

References

1. Todd, P.A., and Goa, K.L., 1990. Simvastatin. Drugs, 40(4), pp.583-607.

2. Amin-Hanjani, S., Stagliano, N.E., Yamada, M., Huang, P.L., Liao, J.K., and Moskowitz, M.A., 2001. Mevastatin, an HMG-CoA reductase inhibitor, reduces stroke damage and upregulates endothelial nitric oxide synthase in mice. STROKE-DALLAS-, 32(4), pp.980-984.

3. Henwood, J.M., and Heel, R.C., 1988. Lovastatin. Drugs, 36(4), pp.429-454.

4. Lea, A.P., and McTavish, D., 1997. Atorvastatin. Drugs, 53(5), pp.828-847.

5. Plosker, G.L., and Wagstaff, A.J., 1996. Fluvastatin. Drugs, 51(3), pp.433-459.

6. Carswell, C.I., Plosker, G.L., and Jarvis, B., 2002. Rosuvastatin. Drugs, 62(14), pp.2075-2085.

7. Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators, 2006. High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine, 355(6), pp.549-559.

8. Olsson, A.G., Istad, H., Luurila, O., Ose, L., Stender, S., Tuomilehto, J., Wiklund, O., Southworth, H., Pears, J., Wilpshaar, J.W. and Group, R.I., 2002. Effects of rosuvastatin & atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia. American Heart Journal, 144(6), pp.1044-1051. 

9. Patel, B.V., Leslie, R.S., Thiebaud, P., Nichol, M.B., Tang, S.S., Solomon, H., Honda, D. and Foody, J.M., 2008. Adherence with single-pill amlodipine/atorvastatin vs. a two-pill regimen. Vascular health & risk management, 4(3), p.673.

10. Rossebø, A.B., Pedersen, T.R., Boman, K., Brudi, P., Chambers, J.B., Egstrup, K., Gerdts, E., Gohlke-Bärwolf, C., Holme, I., Kesäniemi, Y.A. and Malbecq, W., 2008. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. New England journal of medicine, 359(13), pp.1343-1356.

11. Tousoulis, D., Charakida, M., Stefanadi, E., Siasos, G., Latsios, G., and Stefanadis, C., 2007. Statins in heart failure. Beyond the lipid-lowering effect. International journal of cardiology, 115(2), pp.144-150.

12. Gillett Jr, R.C., and Norrell, A., 2011. Considerations for safe use of statins: liver enzyme abnormalities and muscle toxicity. American family physician, 83(6), pp.711-716.

13. Schonewille, M., de Boer, J.F., Mele, L., Wolters, H., Bloks, V.W., Wolters, J.C., Kuivenhoven, J.A., Tietge, U.J., Brufau, G. and Groen, A.K., 2016. Statins increase hepatic cholesterol synthesis and stimulate fecal cholesterol elimination in mice. Journal of lipid research, 57(8), pp.1455-1464.

14. Mohaupt, M.G., Karas, R.H., Babiychuk, E.B., Sanchez-Freire, V., Monastyrskaya, K., Iyer, L., Hoppeler, H., Breil, F., and Draeger, A., 2009. Association between statin-associated myopathy & skeletal muscle damage. Cmaj, 181(1-2), pp.E11-E18.

15. Alsheikh-Ali, A.A., and Karas, R.H., 2009. The relationship of statins to rhabdomyolysis, malignancy, & hepatic toxicity: evidence from clinical trials. Current atherosclerosis reports, 11(2), pp.100-104.

16. Stuart, S.A., Robertson, J.D., Marrion, N.V., and Robinson, E.S., 2013. Chronic pravastatin but not atorvastatin treatment impairs cognitive function in two rodent models of learning and memory. PloS one, 8(9).

17. US FDA https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-important-safety-label-changes-cholesterol-lowering-statin-drugs

See: Lowering Your Cholesterol with Diet Plan

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