So, Your Doctor Wants You to Take a Statin. What Are the Risks?

If you have high cholesterol and cardiovascular risk factors, you may be prescribed a statin. Should you be concerned about the risks of these drugs?

Seems my doctor wants me to take one too. I had my annual check-up with my physician a few weeks ago and was disappointed when I received my lab results. Even after losing 25 pounds over the past 12 months, my overall cholesterol and LDL (low density lipoproteins), also known as “bad cholesterol” because high levels of it boost your risk for a heart attack, have both gone up.

I’m an active person who exercises regularly, my blood sugar level is low and I think I eat a fairly good diet. Generally speaking I consider myself to be healthier than I’ve been for a long time.

My cholesterol level has been a little high for many years, probably due to genetics. Both my father and mother and their parents had high cholesterol. This familial hypercholesterolemia has never seemed to be a problem over the years for me but now my doctor wants me to start taking a statin to lower it. I have some concerns about potential side effects from taking this cholesterol-lowering medication. But more on this later.

I’ve avoided taking a statin for several years. I’ve tried the diet/exercise route. In 2007, I started cycling again and have logged nearly 15,000 miles either riding outside or peddling my bike on a trainer in the garage. In December 2017, I had a check up and decided I needed to lose weight to reduce my blood pressure and cholesterol. I started a keto diet and lost 25 pounds since then. But the high protein, high-fat diet seemed to kick up my cholesterol rather than lowering them. Now I feel it’s time to start a statin, rethink my diet and see what happens.

How Often Should You Get Your Cholesterol Checked?

The American Heart Association (AHA) recommends that all adults should have their cholesterol level checked every 4-6 years starting at age 20. As we age our cholesterol levels tend to rise. If your cholesterol level is high it should be checked more frequently — at least annually. And if you have a family history of high cholesterol, it should be monitored several times a year.

Your doctor will conduct a risk assessment to determine if you need to take a cholesterol medication. If you have high cholesterol but are considered “heart healthy” and have no additional risk factors, you might not need to take medication. If you have additional risk factors like diabetes, high blood pressure, a smoker or family history of heart disease or high cholesterol, they will usually recommend you take medication to control your cholesterol. If you’ve already suffered a heart attack or stroke, chances are you will be prescribed medication to prevent a future one if you’re not already taking one.

Statins are generally considered the first-line treatment for high cholesterol. There are a number of these medications available including Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin) and Pravachol (pravastatin). Your doctor’s personal prescribing habits will determine which statin you are prescribed, though they are all available as generics, so they are cheap.

What Are The Minor and Serious Side Effects?

Generally speaking statins are safe and well tolerated by your body with minimal or temporary side effects such as headache, nausea, drowsiness, flushing of the skin or difficulty sleeping at times. Some of the more serious side effects that have been reported are muscle aches and pain. Mild muscle soreness, tiredness or weakness might be a minor discomfort in most cases but can be severe enough to make daily activities difficult in a few individuals. Very rare serious side effects may include muscle damage (rhabdomyolysis), liver or kidney failure but the risks are very low with incidence being calculated as only a few cases per million statin users.

The AHA issued a statement this week that based on an analysis of decades of clinical studies involving different statins, side effects are very rare and the benefits of them greatly outweigh the risks. The AHA’s action was likely a response to a study that came out last week that argued that statins are overprescribed and for some people who take them, the risks outweigh the benefits.

Treatment needs to be individualized for you based on your risk factors. You (and I include myself) need to understand the risks of not taking a statin vs. your risk of having a heart attack or stroke. Make sure you have this conversation with your doctor. And, as always, ask questions if you don’t understand.


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Dave Walker, RPh

Dave Walker, RPh, is a pharmacist and a member of the MedShadow medical advisory board. He has practiced in multiple pharmacy settings as a pharmacy owner, hospital director of pharmacy, district manager for a pharmacy staffing agency, and currently director of pharmacy at a rural, nonprofit clinic and pharmacy. You can follow him on Twitter @drwalker_rph.


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