Research shows that only 35% of people taking statins actually use them. How do you know if you should be in them?

About 86 million adults in the United States have high cholesterol, which increases the risk of heart disease and stroke. Despite these high numbers, only 35% of American adults who could benefit from cholesterol-lowering medication actually take it.

Although several drugs can help, a common class of cholesterol-lowering drugs is statins. However, you’re not alone if you’re not entirely sure how they work, when to continue them, and if there are any potential side effects you should be concerned about. So what about statins and how safe are they? Cardiologists break it down.

How exactly do statins work?

The main function of statins is to lower cholesterol. Statins work in the liver to block a pathway that produces cholesterol, Dr. Blair Suter, a cardiologist at The Ohio State University Wexner Medical Center, tells Yahoo Life.

Your liver responds to statins by taking cholesterol particles from the blood more easily, leaving less cholesterol in the blood, says Dr. Yu-Ming Ni, a cardiologist and lipidologist at the MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. , reports Yahoo Life. (Higher levels of cholesterol in the blood can damage blood vessels, increasing the risk of heart attack or stroke, he explains.)

The more cholesterol you have in your blood, the faster it attaches to plaques on the walls of your blood vessels, Dr. Alexander C. Fanaroff, an assistant professor of medicine in the Division of Cardiovascular Diseases at the University of Pennsylvania, tells Yahoo Life. If the plaques grow too large, they can block blood flow to the heart or brain, causing a heart attack or stroke, he says. Therefore, lowering cholesterol with statins can help reduce the risk of heart attack or stroke.

There’s also some data that statins reduce inflammation, Ni says, noting that this may also help reduce the risk of heart attack or stroke.

Who needs statins?

The US Preventive Services Task Force (USPSTF), the American College of Cardiology (ACC), and the American Heart Association (AHA) say that the following groups of people may benefit from statins:

  • People with one or more cardiovascular risk factors and a higher 10-year risk of having a heart attack. This includes people with diabetes, high cholesterol, or high blood pressure, as well as people who smoke.

  • People with cardiovascular disease. These are patients with heart disease associated with hardened arteries, including those who have had heart attacks or strokes from a blocked blood vessel, a small stroke, peripheral artery disease, or surgery to open or replace coronary arteries.

  • People with high LDL (bad) cholesterol. This applies to adults with LDL cholesterol levels of 190 mg/dL or higher.

  • Adults with both diabetes and high cholesterol. This applies to adults aged 40 to 75 years who have diabetes and an LDL cholesterol level between 70 and 189 mg/dL.

Statins reduce the risk of heart attack, stroke or cardiovascular death by about 30%, says Fanaroff. This means that a person’s 10-year risk is 7.5% if they are not taking statins and medication would reduce the risk to about 5%. If a person’s risk is higher, such as 25%, statins reduce the risk by about 17%, Fanaroff notes.

Are statins safe?

Although doctors agree that statins are safe and well tolerated by most people, some patients are concerned about taking them. People may be concerned about starting statins because of potential side effects related to liver, muscle and cognitive impairment, Suter says.

They often stem from a 2012 warning from the Food and Drug Administration that noted that people who took statins reported dealing with a variety of health problems, including:

  • Short-term memory loss and confusion that went away when people stopped taking the drug

  • An increase in blood sugar levels

  • In rare cases, serious liver problems

But again, the data is mixed. Research has been conflicting and controversial about all of these side effects, Suter says. A 2021 study published in the Journal of the American College of Cardiology analyzed data on statin use in 18,446 people age 65 and older. The researchers found that people who took statins were no more likely to develop dementia during the five-year study period than people who did not take the drugs. There were also no differences in memory, language and executive function.

Another study, published in the journal Scientific Reports, analyzed data from 55,114 people taking statins and compared them with 245,731 people not taking the drugs. The participants’ reaction time, working memory and fluid intelligence (ability to reason and think flexibly) were measured at the beginning of the study and in two follow-ups within 5-10 years. The researchers found that older people who took statins had better reaction times and fluid intelligence, while younger people had better fluid intelligence but poorer working memory. As a result, the researchers concluded that the effect of statins may vary with age.

When it comes to blood sugar levels, research shows that in patients at high risk of developing atherosclerotic disease, the hardening of the arteries caused by plaque buildup, the benefits of taking statins outweigh the risk of new diabetes. This benefit-risk relationship is less clear and should be discussed with the health care provider in patients without diabetes who have either zero or only one risk factor for atherosclerotic disease.

As for liver disease, a 2023 study of more than 1.7 million people published in JAMA Network Open found that regular use of statins was associated with a 15% lower risk of developing liver disease and a 28% lower risk of dying from liver-related disease. compared to people who did not use drugs. People who regularly took statins also had a 74% lower risk of developing liver cancer.

What are the possible side effects of statins?

Although there are more serious potential side effects that are still being studied, statin users may experience some minor problems.

The most common side effect of statins is muscle pain, Dr. Samuel Kim, a preventive cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center, tells Yahoo Life. Kim says this is generally more common in clinical practice than large clinical trials suggest. However, Kim says side effects will improve with time and dose adjustments. Side effects can also include fatigue and a rise in blood sugar, but they are rarer, he says.

Even patients with side effects can often tolerate the medication when they reduce the statin dose or try the drug again after a temporary break, Kim says.

Why don’t more doctors prescribe them?

A study published in the Annals of Internal Medicine in early December analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2018 and found that while the use of statins to prevent cardiovascular disease increased during that time, only 35% of people who are eligible actually took the drugs. use them.

The researchers theorize that many doctors don’t have the time to do the multi-step risk calculation required to prescribe statins, so they just don’t prescribe the drugs. When you give primary care providers hypothetical patient scenarios and ask whether these patients should be prescribed statins, primary care providers tend to follow the guidelines closely and prescribe statins to eligible people, Fanaroff says. To me, this suggests that more doctors are not prescribing statins because they are too busy with short clinic appointments to take care of everything a patient needs, and preventive care can be sacrificed to treat more pressing concerns.

Fanaroff emphasizes that it is not a case of doctors being lazy. In one study, researchers showed that it would take primary care providers 26.7 hours to take care of all the acute and preventive needs of patients in one day, which is obviously impossible, he says. Research from our group and others shows promise for enlisting other members of the health care team, such as nurses and pharmacists, to help prescribe statins to the appropriate people.

But Ni says the problem is more complex than the time available. There is a lot of misinformation about statins, he says. “I’ve heard patients complain that cholesterol isn’t important in reducing heart disease, that statins damage the liver and cause dementia, and even that doctors are dealing with pharmaceutical companies to make money off statins, none of which is true,” he says.

Kim agrees. Statins have proven to be a very safe drug and well tolerated by the majority of the population, he says. Risks and benefits should be discussed between the service provider and the patient. Statins are still very underused.

Ni emphasizes that statins are also cheap. They are one of the most cost-effective treatments we have to fight America’s number one killer: heart disease, he says.

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