• Preventive Cardiology: Statins


    Common Names

    • Lovastatin (Altoprev, Mevacor)
    • Simvastatin (Zocor)
    • Pravastatin (Pravachol)
    • Fluvastatin (Lescol)
    • Atorvastatin (Lipitor)
    • Rosuvastatin (Crestor)

    Current Uses


    Statins may be prescribed if you have:


    If you already have cardiovascular disease, your doctor may recommend statins to reduce your risk of having a heart attack or stroke. Some people may benefit from a statin even if they have no history of cardiovascular disease but are at high risk.

    Mechanism for How It Works

    HMG-CoA reductase is an enzyme that helps your body make cholesterol. Statins help to block this enzyme, which in turn causes your body to make less cholesterol. When you make less cholesterol, your liver makes more LDL receptors, which attract LDL particles in the blood. This reduces the amount of LDL ("bad") cholesterol in your bloodstream. Lower LDL cholesterol levels also tend to lead to lower levels of triglycerides and higher HDL (“good”) cholesterol levels in the blood. Statins have anti-inflammatory effects on blood vessels which help reduce the formation of fatty plaque on blood vessel walls.

    Side Effects

    Drug Interactions

    Statins can interact with many medicines. Below are some examples. But, you should talk to your doctor and pharmacist about the specific medicines that you are taking.
    • Cyclosporine (eg, Gengraf)
    • Erythromycin (eg, Erythrocin)
    • Gemfibrozil (eg, Lopid)
    • Nefazodone (eg, Serzone)
    • Verapamil (eg, Calan)
    • Digoxin (eg, Lanoxin)
    • Protease inhibitors to treat HIV, such as indinavir (eg, Crixivan), nelfinavir (eg, Viracept), ritonavir (eg, Norvir), saquinavir (eg, Invirase)

    Other Interactions

    Statins can interact with certain foods, herbs, and supplements. Here are examples of potential interactions:
    • Grapefruit juice —increases the absorption of most statins, allowing potentially excessive levels to build up in the bloodstream
    • Chaparral, comfrey, and coltsfoot—may increase the risk of liver problems
    • St. John’s wort—may decrease blood levels of some statins
    • Vitamin B3— possibly increases the risk of developing a potentially fatal condition called rhabdomyolysis
    • Red yeast rice—contains a mixture of statins and should not be combined with statin drugs
    If you would like to take herbs or supplements while taking a statin, check with your doctor first.

    Other Potential Concerns

    These conditions can affect how your body uses statins:
    • Allergy or intolerance to statins or allergies to other substances, including food
    • Obesity—can make statins less effective
    • Positive changes in diet and exercise—may need a lower dose
    If you have any of the following conditions, tell your doctor before you are prescribed statins:
    • Alcohol abuse
    • Liver disease
    • Organ transplant and take medicine to prevent transplant rejection
    • Recent major surgery
    • Pregnant or breastfeeding—Statins are not recommended in pregnant or nursing women.

    Common Side Effects

    More common side effects include:
    • Gas
    • Upset stomach
    • Abdominal pain
    • Diarrhea
    • Constipation
    • Headache
    • Flu-like symptoms
    • Fatigue
    • Muscle pain
    • Skin rash

    Less Common Side Effects

    Less common, but more serious side effects include:
    • Liver problems
    • Myopathy (muscle weakness)
    • Rhabdomyolysis
    • Kidney failure
    • Memory problems and confusion
    • Increased blood sugar levels


    • Take only the amount of statin ordered by your doctor.
    • Do not stop taking this medicine without first checking with your doctor.
    • Tell your doctor or dentist about taking this medicine before having any kind of surgery, dental procedure, or emergency treatment.


    American Heart Association http://www.heart.org/

    US Food and Drug Administration http://www.fda.gov/


    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    Heart and Stroke Foundation of Canada http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.2796497/k.BF8B/Home.htm


    Amarenco P, Bogousslavsky J, Callahan A III, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med . 2006;355:549-59.

    Drug Therapy for Cholesterol. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol%5FUCM%5F305632%5FArticle.jsp . Updated June 14, 2012. Accessed December 14, 2012.

    Grundy SM, Cleeman JL, Merz CN et al. National Heart, Lung, and Blood Institute, American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Circulation . 2004;110:227-239.

    Keeping cholesterol under control. US Food and Drug Administration website. Available at: http://www.fda.gov/ . Accessed on January 28, 2003.

    Lemaitre RN, Psaty B, Heckbert SR, et al. Therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults. Arch Intern Med . 2002;162:1395-1400.

    Lipid-Lowering Pharmacotherapy Overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 3, 2012. Accessed December 14, 2012.

    Middleton A, Binbrek AS, Fonseca FA, et al. Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis. Curr Med Res Opin . 2006;22: 1181-91.

    Statins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 24, 2010. Accessed December 9, 2010.

    Statins. United States Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm294358.htm. Updated November 21, 2012. Accessed December 14, 2012.

    Statin Drugs. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthlibrary. Updated July 25, 2012. Accessed December 14, 2012.

    Stender S, Schuster H, Barter P, et al. Comparison of rosuvastatin with atorvastatin, simvastatin, and pravastatin in achieving cholesterol goals and improving plasma lipids in hypercholesterolaemic patients with or without the metabolic syndrome in the MERCURY I trial. Diabetes Obes Metab. 2005;7:430-8.

    Tahara N, Kai H, Ishibashi M, et al. Simvastatin attenuates plaque inflammation: evaluation by fuorodeoxyglucose positron emission tomography. J Am Coll Cardiol . 2006;48:1825-31.

    1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol. 2008;52:1769-1781.

    3/6/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm. Published February 28, 2012. Accessed March 6, 2012.

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