What should I do if my statin doesn't work?
Statins lower cholesterol for millions of people. They also can help protect you from heart attacks and strokes. But for some people who take them, they don’t work well enough. If your statin doesn’t help, don’t worry. Your doctor can help you find other treatments.
What are the treatment options for statin-related adverse events?
The first step is to determine whether the adverse events are indeed related to statin therapy. If so, lowering the dosage or changing statin, alternate dosing options, or the use of nonstatin compounds may be practical strategies.
Should we lower the risk threshold for statin treatment?
Lowering the threshold for statin treatment to 3% or 4% could avert another 125,000 and 160,000 cardiovascular events, respectively. Depending on assumptions about benefits and risks, these risk thresholds might also be considered cost-effective options.
When to switch statins in the treatment of statins?
If symptoms do not resolve, it is advisable to restart with the same statin at a lower dosage or to switch to another statin. The selection of the new statins should favor molecules metabolized via different pathways. In patients with a recurrence of symptoms, different approaches should be considered.
What to do if patient Cannot tolerate statins?
In patients with statin intolerance, it may be advisable to change the dose, switch to a different statin, or try an alternate-day regimen. If intolerance is associated with all statins—even at the lowest dose—non-statin drugs and certain nutraceuticals can be considered.
Should people with rheumatoid arthritis take statins?
Should RA patients be treated similarly? According to a new study, published in the journal Arthritis & Rheumatology, statins are indeed safe and effective for people with RA.
Which statin is best for rheumatoid arthritis?
Conclusions: Atorvastatin significantly reduced arterial stiffness in patients with RA. The greatest improvements were seen in patients with more active disease, suggesting that, in addition to the beneficial effects of cholesterol reduction, immune modulation may contribute to the cardioprotective effect of statins.
What happens if statins are stopped?
Stopping your statin has been linked to increased risk for cardiovascular events (like heart attack) and death in patients with coronary artery disease. In a recent 8-year study, more than half of patients stopped their statin believing they were experiencing a side effect.
Can statins make RA worse?
Results: Cases were more often users of statins (15.9%) compared to controls (8.6%). After adjustment for cardiovascular risk factors and use of comedication, statin use was associated with an increased risk of incident RA (adjusted OR, 1.71 (95% CI 1.16 to 2.53); p=0.007).
Can statins trigger rheumatoid arthritis?
Use of statins is associated with an increased risk of rheumatoid arthritis.
Does Lipitor help rheumatoid arthritis?
After six months, the patients who took Lipitor did a bit better than the others. They had lower scores on a medical index of rheumatoid arthritis activity. And they had fewer swollen joints, although they did not report significantly better health.
Do statins reduce arthritis inflammation?
But statins also have strong anti-inflammatory properties. When it comes to osteoarthritis, statins may reduce the level of inflammatory cytokines (proteins released by the immune system) and interfere with the immune system's T cells — both of which influence osteoarthritis, MedPage Today reports.
Can Atorvastatin be taken with hydroxychloroquine?
This shows that the combination has improved the protein metabolism. Atorvastatin with hydroxychloroquine can offer a new and promising approach in the management of diabetes mellitus, due to its multifaceted action.
Is there a natural substitute for statins?
Natural alternatives to statins include soy products like tofu and edamame. According to the Centers for Disease Control and Prevention, more than 35 million Americans have high LDL, also known as bad cholesterol. This greatly increases your risk for heart disease and stroke.
Is there a non statin cholesterol medication?
There are many non-statin medications your doctor might prescribe: Bile acid-binding resins, like cholestyramine (Locholest, Prevalite, Questran), colesevelam (WelChol), and colestipol (Colestid) stick to cholesterol-rich bile acids in your intestines and lower your LDL levels.
How can I lower my cholesterol without medication?
9 Ways To Lower Your Cholesterol Without MedicationLimit unhealthy fats. Your body already makes all the saturated fat it needs and eating too much more can raise your cholesterol. ... Get your omega-3s. ... Eat more fiber. ... Cut back on added sugar. ... Limit alcohol. ... Quit smoking. ... Exercise on most days. ... Develop healthy sleep habits.More items...
What statins are non-approved?
Several studies have evaluated non-approved statin dosing regimens in patients with SIM. Some have tested rapidly metabolized statins, such as lovastatin 48, 49 fluvastatin, 50 or simvastatin. 51 However, this approach has been based on the concept that statins with a longer half-life may maintain their lipid lowering effect over a longer period of time. For example, atorvastatin has a mean terminal half-life of 14 h and generates two active (orthohydroxy and parahydroxy) metabolites. 52 These metabolites contribute to 70% of its HMG-CoA reductase activity and have a half-life of 20–30 h. 53 This justifies the use of atorvastatin in alternate-day dosage as it maintains its cholesterol lowering efficacy for longer.
How to manage intolerance to statins?
The first step in the management of intolerance to statins is to rule out any possible conditions that increase the risk of developing SIM or aminotransferase elevations. A list of the most common of these conditions is reported in Table 1. The National Lipid Association Statin Safety Task Force has provided recommendations for the management of muscle-related symptoms in patients receiving statin therapy 4 and these are incorporated in Figure 1. In summary, in patients with moderate symptoms and without significant CK elevation (< 5 × ULN), progress can be followed clinically. On the other hand, in patients with severe symptoms and in those with CK elevated more than 5 × ULN, statins should be stopped. Once CK is normalized, patients should be rechallenged with the same statin at the same dosage. Otherwise, different approaches can be considered ( Table 2 ). The use of agents (coenzyme Q10 and vitamin D preparation) to alleviate muscular symptoms has also been proposed.
How long does rosuvastatin last?
Rosuvastatin, the other statin that exhibits a long half-life (19 h), has also been employed in trials testing the infrequent statin dosing regimen. Mackie et al 60 described two patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, at 2.5 and 5 mg, respectively. After 6 weeks, LDL-C was reduced by 38% and 20%, respectively with the resolution of adverse effects. In a retrospective analysis of clinical charts at two lipid clinics, 61 51 patients that had experienced statin intolerance were found to be treated with every-other-day rosuvastatin (mean dose 5.6 mg). The authors reported that 72.5% (37 out of 51) of patients were able to tolerate this regimen for 4 months. Mean LDL-C decreased by 34.5% ( P < 0.001) in patients who tolerated the regimen, enabling approximately 50% to achieve their LDL-C goal. Among patients treated with the every-other-day regimen, 27.5% (14 out of 51) re-experienced the symptoms of their prior statin intolerance.
How many adverse events are there with statins?
Several studies have evaluated the incidence of adverse events during statin therapy. In a meta-analysis of over 70,000 subjects in 18 primary and secondary prevention placebo-controlled trials, the number needed to harm (NNH) for any adverse event with statins was 197 versus 27, which was the number needed to treat (NNT) to prevent one cardiovascular event. 5 In other words, treating 1,000 patients would prevent 37 cardiovascular events and cause 5 adverse events. In this analysis, serious adverse events, such as creatine kinase (CK) > 10 times upper limit of normal (ULN) or rhabdomyolysis, are rare and have a NNH of 3,400. Rhabdomyolysis alone was extremely rare with an NNH of 7,428. In the search for differences between statins, this study showed that fluvastatin, the least efficacious, had the lowest rate of adverse events, and atorvastatin, the most efficacious, had the highest rate. Simvastatin, pravastatin, lovastatin, and rosuvastatin appeared to have similar rates of adverse events. In a systematic review of 20 clinical trials, Law and Rudnicka 6 reported that the incidence of myopathy and minor muscle pain incidence was 195 cases per 100,000 patient-years (95% confidence intervals [CI]: −38 to 410). The incidence of rhabdomyolysis was 1.6 cases per 100,000 patient-years (95% CI: −2.4 to 5.5). However, it must be noted that the frequency with which clinicians encounter SIM in real-world clinical practice is often much higher than that reported in clinical trials. One likely explanation for this discrepancy is that the rate of myopathy in clinical trials is artificially underestimated because patients at increased risk for statin-induced adverse effects tend to be excluded prior to randomization. 7 Also, many patients in clinical practices may not be as healthy as those enrolled in clinical trials and often have more severe comorbidities.
What are the biochemical abnormalities of statins?
The most commonly encountered hepatic biochemical abnormality during statin therapy is the asymptomatic eleva tion of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) which appears to be a class effect of statins. 2, 4 This has been also defined as ‘transaminitis’, in which liver enzymes are elevated in the absence of clear hepatoxicity. This condition is usually transient with full resolution following withdrawal of the drug, although this may take several months. It is rare for statins to cause isolated elevations in gamma-glutamyl transferase (GGT). 26 Several reports indicate that the occurrence of aminotransferase elevation during statin therapy ranges from 1%–3%. 27, 28 This effect appears to be dose related 29, 30 and hence may be related to bioavailability. In a recent meta-analysis, 16 it has been shown that atorvastatin 80 mg and simvastatin 80 mg are associated with a persistent elevation of ALT (>3 times ULN) up to 5 times compared to atoravastatin 10 mg and simvastatin 20–40 mg (0.2% vs 1.0%). Hepatocellular injury seen during statin therapy seems to be an early side effect as demonstrated in several statins trials where AST and ALT elevation appeared in the initial 3 months of treatment. 31 Liver-related symptoms occurred on average 4 weeks (range 1 to 8 weeks) after initiation of treatment but resolved within 4 weeks of statin therapy discontinuation.
How long does it take for atorvastatin to lower cholesterol?
In the first study, 54 61 patients with hypercholesterolemia received atorvastatin (10 mg) every other day before bedtime. After 8 weeks of treatment, total cholesterol and LDL-C were lowered by 23% and 30%, respectively, and total triglycerides were reduced by 8%; the increase in high density lipoprotein-cholesterol (HDL-C) level was not statistically significant. For the second study, 55 25 patients with moderate hypercholesterolemia were treated with every-other-day administration of either atorvastatin (mean dose, 18.8 mg) or rosuvastatin (mean dose, 9.7 mg). With atorvastatin LDL-C decreased by 43%, total triglycerides by 22%, and HDL-C cholesterol increased by 9% (n = 9; P < 0.05 for all), while with rosuvastatin, LDL-C decreased by 28%, total triglycerides by 15% and HDL-C increased by 10% (n = 16; P < 0.05 for all).
What are statins used for?
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are the mainstay of lipid-lowering therapy because of their well-established efficacy for reducing cardiovascular disease (CVD) morbidity and mortality in various at-risk populations. 1 In general, statin therapy is associated with rare occurrences of serious adverse events and is considered to be safe. 2, 3 Nevertheless, a significant proportion of subjects taking these drugs may experience some degree of intolerance. In particular, statin-induced myopathy (SIM) is by far the most common side effect. A less common side effect of statin therapy is the increase of serum aminotransferase levels, which is considered the manifestation of hepatic toxicity. 4
How many cardiovascular events can be prevented by statins?
The researchers estimated that between 41,000 and 63,000 cardiovascular events would be prevented over a 10-year period by adopting the ACC/AHA guidelines compared to the previous guidelines.
Why do doctors prescribe statins?
Doctors may prescribe statins along with lifestyle changes to prevent or control cardiovascular disease. Purestock/Thinkstock. Atherosclerosis arises when fat, cholesterol, and other substances accumulate along artery walls and form a sticky buildup known as plaque.
What is the recommended LDL cholesterol level for ASCVD?
Among the recommendations was that people 40 to 75 years of age without clinical ASCVD and diabetes should take statins if they have an LDL cholesterol level of 70 to 189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or more. The guidelines also included methods for making this risk estimate.
Is 7.5% a good risk threshold for statins?
The team found that the health benefits conferred by the current ASCVD risk threshold of 7.5% or higher were worth the incremental costs, according to commonly accepted “willingness-to-pay” public health standards. Lowering the threshold for statin treatment to 3% or 4% could avert another 125,000 and 160,000 cardiovascular events, respectively. Depending on assumptions about benefits and risks, these risk thresholds might also be considered cost-effective options. These estimates can help inform future decisions about balancing costs with quality years of life.
Is cholesterol treatment cost effective?
Two studies found that recent cholesterol treatment guidelines are a cost-effective way to prevent cardiovascular disease. The results suggest that it might be cost effective to lower the threshold for treatment with statins even further. Doctors may prescribe statins along with lifestyle changes to prevent or control cardiovascular disease.
What medications can increase the side effects of statins?
In addition to the drug interactions described above, tell your doctor if you use or plan to use medications that might increase the side effects of statins, such as antifungals, certain antibiotics, calcium-channel blockers, nefazodone, and warfarin (Cou madin and generic).
What is the best medication for rheumatoid arthritis?
Use the lowest possible dose of corticosteroid medications like prednisone for the shortest time possible. Those drugs reduce inflammation in patients with rheumatoid arthritis but might enhance cardiovascular risk.
Is atorvastatin safe for rheumatoid arthritis?
Although atorvastatin was well-tolerated in TARA, there are no data on the long-term safety of statins used by people with rheumatoid arthritis. The following risks associated with statin use for high cholesterol have been reported in the general population:
Can statins help with rheumatoid arthritis?
Now a growing number of experts, as well as new European guidelines, recommend expanding treatment criteria to allow more people with rheumatoid arthritis to take statins.
Does atorvastatin help with arthritis?
In addition, a large observational study from Japan found that people with rheumatoid arthritis who took statins had less pain and lower swollen joint counts than those who did not . And in a very small randomized placebo-controlled double-blind trial (involving just 20 patients), high-dose atorvastatin boosted the anti-inflammatory effects of HDL (good) cholesterol after 12 weeks but did not alter rheumatoid arthritis symptoms.
Does statin affect inflammation?
But others say the studies don't endorse that broader use. "They show a measurable but very small statin effect on some inflammatory scores, like how much joint swelling a patient has," says Eric Matteson, M.D., a professor of medicine and chief of rheumatology at the Mayo Clinic, and chairman of the communications committee of the American College of Rheumatology. "What we're really interested in is: Will those patients live longer? Will they get less joint damage, less joint deformity, and less vascular disease related to the underlying inflammation? All those are unanswered questions."
Can statins cause muscle pain?
Muscle damage might range from mild pain to, in rare cases, rhab domyolysis, in which muscle breakdown can lead to ki dney failure and coma. In a 2010 safety announcement, the FDA warned of an increased risk of muscle injury with 80 mg of simvastatin (Zocor and generic) compared with lower doses and possibly other statins. Muscle risks might also increase in people who use a statin while taking cyclosporine drugs (Gengraf, Neoral), which are used to treat rheumatoid arthritis. In general, the lowest statin dose possible should be prescribed to avoid muscle pain, a side effect in up to 10 percent of the people who take these medications.
How old do you have to be to take statins?
Current guidelines recommend statins for primary prevention — but only for those up to age 75. Yet, almost half of adults aged 75 and older take statins, per Centers for Disease Control and Prevention.
Why is statin therapy important?
With increasing life expectancy, clear guidance on sensible use of statin therapy to prevent a first and potentially devastating ASCVD event is critically important to ensure a healthy aging population.
Can atorvastatin be administered to older adults?
Apart from atorvastatin, the other statins cannot be administered or their dose should be adjusted to GFR.
Do statins make sense?
Statins make sense for a select group of people- those who have clinically diagnosed ASCVD or stroke, or who have had arteries unblocked with a procedure like stenting.
How many people take cholesterol lowering statins?
More than one in four adults ages 45 and older in the United States take a cholesterol-lowering statin. But these popular medications are often misunderstood. Here's what you need to know to take them safely.
Is it safe to take CoQ10 for a month?
Some physicians maintain that trying the supplements for a month or so is likely safe. However, research suggests that CoQ10 may reduce the effectiveness of warfarin (Coumadin). That could raise the risk of a dangerous blood clot, so don't try CoQ10 if you are taking that medication.
Does CoQ10 help with statins?
It's also sold as a dietary supplement and touted as a way to boost energy and "support heart function," as the product labels assert. Taking a statin lowers CoQ10 levels , and scientists have wondered if raising blood levels of CoQ10 might help treat statin-related muscle aches. But so far, the results have been mixed, with no solid evidence to support that idea.
Can statins cause kidney failure?
Other tests measured creatine kinase (CK), a byproduct of muscle breakdown that can signal the early stages of rhabdomyolysis. This condition, which occurs in about one in 10,000 statin users, can lead to kidney failure and even death.
Does grapefruit juice affect statins?
Grapefruit juice affects certain statins more than others. But if you can't switch, a small glass of the juice is probably fine, says Dr. Jorge Plutzky, an associate professor of medicine at Harvard Medical School and medical editor of Managing Your Cholesterol, /MC.
Can statins cause memory loss?
MYTH 1 Statins cause memory loss. Some people who take statins report confusion or memory loss. But because memory issues tend to crop up in middle-aged and older adults (the most common users of statins), it's hard to tell if the drug, or another problem such as age-related memory loss, might be to blame.
Does statin help with muscle pain?
Taking a statin lowers CoQ10 levels, and scientists have wondered if raising blood levels of CoQ10 might help treat statin-related muscle aches. But so far, the results have been mixed, with no solid evidence to support that idea. Some physicians maintain that trying the supplements for a month or so is likely safe.
How old do you have to be to take statins?
The U.S. Preventive Services Task Force recommends low- to moderate-dose statins in adults ages 40 to 75 who have one or more risk factors for heart and blood vessel disease and at least a 1 in 10 chance of having a cardiosvascular disease event in the next 10 years.
How do statins work?
By Mayo Clinic Staff. Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Lowering cholesterol isn't the only benefit associated with statins.
What is the best cholesterol level for a heart attack?
Low-density lipoprotein (LDL) cholesterol. Aim to keep this "bad" cholesterol under 100 mg/dL, or 2.6 mmol/L. If you have a history of heart attacks or you're at a very high risk of a heart attack or stroke, you may need to aim even lower (below 70 mg/dL, or 1.8 mmol/L).
How to reduce risk of heart disease?
To reduce your risk: Quit smoking and avoid secondhand smoke. Eat a healthy diet rich in vegetables, fruits, fish and whole grains and low in saturated fat, trans fat, refined carbohydrates and salt.
Do statins lower cholesterol?
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. These drugs may help stabilize the plaques on blood vessel walls and reduce the risk of certain blood clots. A number of statins are available for use in the United States.
Do you need statins if your LDL is low?
If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L).
Can statins cause kidney damage?
Muscle cell damage. Very rarely, high-dose statin use can cause muscle cells to break down and release a protein called myoglobin into the bloodstream. This can lead to severe muscle pain and kidney damage.
How to get maximum benefit from statins?
To obtain maximum benefit, aim for the highest dose tolerable in those without predisposition for side effects. Use lower doses in people predisposed to side effects or taking medications that could interact with statins. Pay attention to news media. Periodically scan major news headlines about statins and heart disease.
How do statins work?
Statins work by lowering the amount of circulating cholesterol in the blood and halting or slowing the formation of dangerous fatty plaque. Rarely, however, statins can precipitate the onset of other serious conditions, including muscle damage and diabetes.
How do statins affect the heart?
Statins work by lowering the amount of circulating cholesterol in the blood and halting or slowing the formation of dangerous fatty plaque. Rarely, however, statins can precipitate the onset of other serious conditions, including muscle damage and diabetes. The risk of such infrequent side effects pales in comparison with the very real risk of heart attack or stroke among those with established heart disease or history of stroke. However, the risk-benefit balance is much trickier to gauge among those who have no actual disease but whose high cholesterol and other risk factors render them likely yet not definite candidates for heart attacks and strokes.
When did the cholesterol lowering statins come out?
Release Date: March 30, 2015. Cholesterol-lowering statins have transformed the treatment of heart disease. But while the decision to use the drugs in patients with a history of heart attacks and strokes is mostly clear-cut, that choice can be a far trickier proposition for the tens of millions of Americans with high cholesterol ...
What are the 5 M's of statins?
The five M’s of statin use: In their conversations with patients, physicians should discuss the 5M’s of statin side effects: memory, metabolism, muscle, medication interaction and major organ effects. Address each one individually. Use simple arithmetic to convey the difference between expected therapeutic value versus possible harm as a net benefit.
Does statin cause diabetes?
Statin use has been linked to a higher risk of developing diabetes because the medication can fuel mild glucose elevations in predisposed individuals — an effect that can often be countervailed by exercise and losing as little as a few pounds.
Can you take statins with pre-diabetes?
People with pre-diabetes should only be treated with statins if they have a markedly elevated risk of heart attack and stroke. Emphasize to patients that even those who develop diabetes after starting statin therapy derive the same or even greater benefits in terms of reducing their cardiovascular risk. Statins and memory.