Dr. Norman Roth Discusses the Use of Statins

How they work and who can benefit

One of the most common questions I get as a cardiologist pertains to the use of statins. Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Because of their significant benefit in treating and preventing cardiovascular disease, statins are one of the most commonly prescribed classes of medications.  

How statins work

Statins play a key role in improving a cholesterol profile by:

  • Lowering LDL cholesterol, commonly referred to as “bad cholesterol,” given that it is known to be atherogenic or promote the formation of cholesterol plaques in arterial walls. Statins lower LDL cholesterol by preventing the natural production of cholesterol in the body. 
  • Lowering triglyceride levels, which is another form of fat in your bloodstream. Elevated triglyceride levels are also associated with an increased risk of cardiovascular disease.

Lowering cholesterol isn’t the only benefit associated with statins. These medications have also been linked to a lower risk of heart disease and stroke.

Risk factors determine who can benefit from statins

Some confusion understandably arises when I recommend that patients initiate a statin despite having normal or near normal cholesterol levels. This situation can occur when patients have a significantly elevated risk of future cardiovascular events (such as heart attack and stroke) as estimated by their overall risk factor profiles, with cholesterol levels only being one of the components used to assess that risk. 

Other risk factors that determine whether a patient is at increased risk of cardiovascular disease and can benefit from statins include:

  • Gender – men are more likely to have cardiovascular disease at an earlier age; however, by the 7th decade of life, the risk of cardiovascular disease is nearly equal between the sexes.
  • Increasing age
  • High blood pressure
  • Low HDL or “good cholesterol”
  • Obesity
  • Diets rich in meat
  • Trans fat or high glycemic index foods, or foods low in fiber
  • Sedentary lifestyle
  • Systemic inflammatory or autoimmune conditions
  • Chronic kidney disease
  • Family history of premature atherosclerosis
  • Cigarette smoking

Reducing your risk of heart disease or stroke

Based on the combination of these risk factors, if your risk of having a cardiovascular event is determined to be high enough, statin therapy will be recommended to reduce this risk and the risk of cardiovascular death.

In patients with established cardiovascular disease (peripheral arterial disease, carotid arterial disease, coronary artery disease, abdominal aortic aneurysm, or diabetes mellitus), statin therapy is recommended regardless of LDL cholesterol levels for the prevention of cardiovascular events or death. This is because statins have other positive effects on the cardiovascular system separate from lowering cholesterol. Statins promote normal functioning of the cells lining our blood vessels, reduce local inflammation, and stabilize plaque already in the artery, preventing it from rupturing and causing a heart attack or stroke. 

Side effects of statins

Patients are often understandably concerned about side effects with statins and, fortunately, they are usually mild.

  • Benign liver enzyme elevations can occur but more severe liver injury is rare. 
  • Muscle pains related to statins can occur, but these are often benign and can resolve with reduction in the dose, increasing the dosing interval, or if necessary, with cessation of the drug. More significant muscle damage or injury is fortunately a rare occurrence.
  • There has not been medical research definitively showing that statins harm cognition or lead to behavioral changes.
  • Some studies have shown a slightly increased risk of developing diabetes mellitus; however, their beneficial effects in regard to cardiovascular risk reduction and reduction in mortality far outweigh the cardiovascular risk conferred from the development of diabetes mellitus in these patients.

Statins play a key role in reducing cardiovascular risk

Overall, statins have had a dramatic impact in the field of cardiovascular medicine and have some of the best medical evidence supporting their efficacy and safety in the prevention of cardiovascular disease, cardiovascular events, and cardiovascular death in patients that meet criteria for their use. 

Talk to your cardiologist to learn more and determine if you are a good candidate for statins.