Fighting High Cholesterol with Statins

By Jane Farrell

You go to the gym faithfully, and you try to watch your diet. But after your annual physical, you find out that your blood cholesterol is surprisingly high. Your doctor calls you back to discuss taking a medication known as a statin.

Here, in a Consumer Update, the federal Food and Drug Administration (FDA) answeres some commonly asked questions about cholesterol and statins.

1. What are statins? How do they work?

Statins are a class of medicines used to lower cholesterol in the blood. Most of the cholesterol in your blood is made by the liver. Statins work by reducing the amount of cholesterol made by the liver and by helping the liver remove cholesterol that is already in the blood.

According to James P. Smith, M.D., M.S., deputy director of the Division of Metabolism and Endocrinology at the FDA, “An important first step is to have a discussion with your healthcare provider about your risk of having heart disease or a stroke, how a statin would reduce that risk, and any side effects that you should consider.”

2. Why is it important to keep cholesterol levels in the blood low?

Your body needs cholesterol, but too much of it in your blood can lead to buildup on the walls of your arteries (this buildup is called “plaque”), putting you at higher risk for heart disease and stroke. According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both men and women in the United States.

3. I’ve heard about “good” and “bad” cholesterol. What’s the difference?

Cholesterol is carried in the bloodstream on different types of particles, called lipoproteins. The majority is carried on low-density lipoprotein (LDL) particles and is sometimes referred to as “bad” cholesterol, because high levels of LDL particles can lead to heart disease and stroke. High-density lipoprotein (HDL) particles, on the other hand, carry cholesterol back to the liver for removal from the body. Since people with higher levels of HDL-cholesterol tend to have a lower risk of heart disease, this is sometimes referred to as “good” cholesterol. Your healthcare provider should help you interpret what your numbers mean for your cardiovascular health.

4. I thought a healthy diet and regular exercise would keep my cholesterol in check. Not so?

“A heart-healthy diet, regular physical activity, and maintaining a healthy weight are all very important components of a lifestyle that can help lower cholesterol and reduce the risk of heart disease and stroke,” says Smith. “But other factors that are out of our control, such as genetics, also play a role. For many people, cholesterol simply cannot be lowered enough by lifestyle changes alone.”

For people who are at increased risk of having a heart attack or stroke, statins may be recommended even when cholesterol levels might not seem too high. “Statins have a well-established track record for reducing the risk for heart attacks and strokes,” Smith says. “Whether or not a statin is appropriate for a specific patient should involve a conversation between the patient and his or her healthcare provider.”

5. I’ve heard that there are some risks to taking statins. Should I be worried?

Statins are typically very well tolerated. Two risks that patients may be aware of are muscle-related complaints and an increased risk of developing type 2 diabetes. “Muscle complaints are quite common even among people not taking statins, so it is important to have your healthcare provider evaluate any symptoms before stopping your medication,” Smith explains. “It is rare for statins to cause serious muscle problems.”

Similarly, the risk of developing diabetes as a result of a statin is small. “The benefits of statins in reducing heart attacks and strokes should generally outweigh this small increased risk,” Smith says.

6. I’ve heard you shouldn’t drink grapefruit juice if you’re taking a statin. Is that true?

Grapefruit juice and fresh grapefruit can affect the way some medicines work. That’s true with certain statins, too—but only some of them. In addition, other medications can also interact with statins. Smith advises patients ensure that their healthcare provider and pharmacist know about all the prescription and non-prescription medications they take.

For more health information from the FDA, click here.