Need a Cholesterol Drug? 12 Must-Know Facts
No one really likes having to take medications, but millions of people in the United States (and around the world) are on cholesterol-lowering drugs to reduce their heart disease risk.
There are several treatments for high cholesterol, including niacin, bile-acid resins, fibrates, and Zetia, a cholesterol-absorption inhibitor. But statins get all the attention (and many say, rightly so) because they’ve been shown to lower the risk of heart attack and stroke.
A newer, pricier class of cholesterol-lowering medicines, called PCSK9 inhibitors, also shows beneficial reductions in these unwanted health problems, although longer-term studies are needed.
If you are one of the millions taking or considering a cholesterol-lowering medicine, here are 12 important facts you should know.
RELATED: 5 Reasons to Stop or Switch Statins
They’re not for everyone
Statins and other cholesterol drugs work, but they are not for everyone. All have side effects, and some of them, including statins, may cause birth defects if taken during pregnancy.
"We don't recommend statins or other cholesterol drugs for women of childbearing age," says Antonio M. Gotto Jr., MD, professor of medicine at Weill Cornell Medicine in New York City. (One exception would be for very high-risk women with genetically determined high cholesterol who are on birth control, he says.)
Before taking niacin (a B vitamin) or any other over-the-counter products to lower your cholesterol, talk to your doctor about the benefits and risks.
Experts don’t entirely agree on who may benefit
More people than ever are eligible for statins, including folks at “average risk” of having a heart attack or stroke, Dr. Gotto says. But guidelines on who should receive preventive treatment differ a bit.
“We recommend statins after diet and exercise if the 10-year risk of an event [such as a heart attack or stroke] is greater than 7.5%,” Dr. Gotto adds, citing a metric developed by the American College of Cardiology and American Heart Association.
By contrast, the U.S. Preventive Services Task Force recommends statins if the risk is 10% or greater.
What’s a patient to do? Ask your doctor: “What makes you say that you think it’s time to use a statin?” advises Alfred Casale, MD, chair of the Geisinger Heart Institute in Danville, Pennsylvania.
You can’t ignore your diet
Your LDL may drop once you start taking the medication, but these aren't magic pills. You still may need to lose weight, eat a low-fat diet, and exercise.
"Medication doesn't take the place of a healthy lifestyle," Dr. Gotto says. "Just because you take a statin doesn't mean you can forget about diet and exercise. The drug is much more effective, even at lower doses, if you follow a healthy lifestyle," he adds.
Changing your diet and exercising more can lower your cholesterol by 4% to 13%. Statins lower cholesterol by 20% to 45%, depending on the type.
Watch for side effects
All drugs have side effects, and cholesterol-lowering drugs are no exception. Although many side effects are more of a nuisance than anything else, some can be serious.
Statins, for example, may increase the risk of muscle-tissue damage, and there's a rare risk of liver injury. Taking statins can also boost blood sugar levels, leading to diabetes (although the benefit is greater than the risk, Dr. Gotto says). Taking certain antibiotics, immune-suppressing agents, antiviral medicines, antifungal medications, or other cholesterol drugs along with statins can boost the risk of serious side effects.
Common cholesterol-drug side effects include nausea, stomach pain, constipation, or diarrhea; drowsiness; and muscle aches, weakness, or facial flushing. Talk with your doctor about switching to a different drug if you experience side effects.
Not all are pricey
Cholesterol drug prices vary depending on the type, dosage, where you buy it, your insurance, and whether you're a cash-paying customer using a coupon or discount card.
If you shop around, you might pay $5 to $10 a month for generic simvastatin (Zocor). An extended-release version of fluvastatin (Lescol XL) could set you back upwards of $200 a month–or less than half of that if you’re paying out of pocket with a discount or coupon.
If cost is an issue, talk to your doctor about less expensive alternatives or pill splitting. Prescription assistance programs could also help you afford brand-name drugs.
There are some surprising benefits
Statins are heralded for their cholesterol-lowering potential. But they convey other health benefits too.
Some evidence suggests statin users could be less vulnerable to developing Alzheimer’s disease and that people with chronic obstructive pulmonary disease (COPD) who take these drugs may live longer. Statin use also has been linked to a reduced rate of kidney stone formation.
Statins have “a pretty potent anti-inflammatory effect,” adds Dr. Casale. They quiet the signal that tells your body something needs fixing and inhibit the cascade of white blood cells that cause inflammation, he says. Less inflammation means lower rates of heart attack and injury to the inner lining of blood vessel walls, for example.
Most people don’t take them correctly
The American Heart Association considers failure to take medication a major threat to patients. Some people simply forget; others skip or neglect medicines because they're worried about costs or side effects.
Research suggests that of people given a prescription, 12% don't fill it, 12% fill it but don't take it, and another 22% start taking it but then stop.
"If you look at the people who are given statins after a cardiac event, only half are still taking their medications within five years," Dr. Gotto says.
Grapefruit juice can be a problem
"Grapefruit juice can make statins more potent, so you may get side effects," Dr. Gotto says.
This is not true with other citrus fruits or with other cholesterol medications. But the compounds in grapefruit can affect how statins are absorbed in your GI tract, and this can increase the levels of the drug in your body to dangerous levels.
If you are taking statins, your best bet is to avoid grapefruits, any type of grapefruit juice, or juice blend that contains grapefruit juice.
Tell your doctor about herbs, supplements
Many people pop multiple vitamins, minerals, or herbs to improve their health. Let your doctor know what you are taking. Some supplements may increase or decrease the effectiveness of cholesterol-lowering drugs.
For example, St. John's Wort could make some statins less effective. Many supplements, including red yeast rice and niacin, may affect cholesterol levels, so taking them could influence how well your medication works.
Taking fish oil instead of a statin? Talk to your doctor. While these supplements reduce triglycerides (a type of blood fat), there's no proof that they lower your bad cholesterol or reduce your risk of heart attack and stroke.
They interact with other medication
It's not just food and supplements that can interfere with the effects of your cholesterol meds. Prescription pills such as antifungal or antibiotic drugs can increase your risk of statin side effects, according to the American Heart Association.
Statins may interact with drugs including calcium channel blockers such as diltiazem and immunosuppressants such as cyclosporine. Gemfibrozil (a fibrate drug for reducing cholesterol) should not be used with statins, and niacin may interact with many drugs, including blood-pressure and diabetes medicines.
It may take trial and error to find the right drug and dose.
Zocor (simvastatin) can't exceed 20 milligrams if it is prescribed with the blood-pressure drug amlodipine, ranolazine for chest pain, or amiodarone, an anti-arrhythmic drug. There is 10-milligram limit on Zocor when taken with the calcium channel blockers verapamil and diltiazem. You can't take Zocor at all with the cholesterol-lowering fibrate drug gemfibrozil or protease inhibitors for HIV.
"This does not mean that simvastatin is a bad drug; it just must be adjusted for potential drug interactions," says Robert S. Gold, RPh, MBA, author of Are Your Meds Making You Sick?
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter
Cholesterol remedies are for life
Once you start taking a statin or another cholesterol-lowering drug, you must continue taking them forever, or switch drugs if one isn't working or is causing side effects.
Some people mistakenly believe they can stop taking a statin once their cholesterol comes down, but "once you stop, the cholesterol goes back up and you lose the benefit," Dr. Gotto explains.
If you think your statin isn't working for you, talk to your doctor about your options.