Statins: What are the Pros and Cons?

Maintaining healthy cholesterol levels lowers your risk of heart disease. A healthy, balanced diet with regular exercise is important to help prevent and treat high cholesterol but in some people, medications may also be needed.

Statins are a commonly prescribed medication used to lower circulating LDL (“bad”) cholesterol levels by blocking an enzyme in the liver involved in producing LDL cholesterol. Lowering LDL cholesterol levels has been shown to reduce the risk of heart attack and stroke. Statins also benefit the heart, blood vessels, and other organs due to their anti-inflammatory properties. Some of the most commonly prescribed statins include atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor).

A recent Centers for Disease Control and Prevention (CDC) report estimates that nearly 1 in 4 adults aged 40 and older in the United States uses a cholesterol-lowering medication, with statins being the most commonly used medication. But while statins are effective, there are known downsides as well. Arun Manmadhan, MD, assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, weighs in on the pros and cons.

Statins Can Cause Challenges for Some

While statins are generally safe, well-tolerated, and effective for most people, they can rarely cause side effects such as muscle pain, liver inflammation, and an increased risk of diabetes. In some special cases, the use of statins may require careful monitoring, such as:

• Underlying advanced liver disease: Statins can increase liver enzyme levels, and if someone has liver disease, it may be difficult for the liver to metabolize the drug properly.
• Pregnancy and breastfeeding: Statins may harm the developing fetus or baby.
• Allergy or hypersensitivity.
• Underlying muscle disease: Statins can exacerbate muscle inflammation/injury in people with active muscle disease.
• Interacting medications: Like all medications, statins can interact with other medicines, such as certain antibiotics, antifungal drugs, and some heart medications, which can increase the risk of side effects.

Alternative Options to Statins

While statins are the most prescribed medication to lower cholesterol, several other types of medications have been shown to be effective. These medications can be used alongside statins or as substitutes for people who cannot take statins. Some examples of alternative medicines for lowering cholesterol levels include:

• Ezetimibe: This medication works by reducing the absorption of cholesterol in the digestive tract.
• PCSK9 inhibitors: PCSK9 inhibitors are a newer class of medications that can lower LDL cholesterol levels by blocking a protein that prevents the liver from removing LDL cholesterol from the bloodstream. Currently, all the PCSK9 inhibitors are injectable drugs, but oral versions are being tested in clinical trials.
• Bempedoic acid: This medication lowers LDL cholesterol by blocking an enzyme involved in the production of LDL cholesterol in the liver.
• Fibrates: Fibrates can help lower triglyceride levels and raise HDL (good) cholesterol levels, but they have limited effects on LDL cholesterol. Fibrates are often used in combination with statins and other cholesterol-lowering medications to achieve better lipid control.

It is important to note that these alternative medications have potential side effects and risks. With that in mind, here are several natural ways to help lower cholesterol levels without statin medications:

• A heart-healthy diet low in saturated fats and trans fats can help lower cholesterol levels. Try eating fewer animal products, such as meat, dairy, and eggs, and increase your intake of fruits, vegetables, whole grains, and legumes.
• Regular exercise, such as walking, cycling, swimming, or running, with the goal of at least 30 minutes of moderate-intensity exercise most days of the week can help regulate cholesterol levels.
• Maintaining a healthy weight can help lower and regulate cholesterol levels.
• Quitting smoking can help lower cholesterol levels and drastically reduce the risk of heart disease.
• Herbal supplements, such as garlic, psyllium, red yeast rice, and artichoke extract, may help lower cholesterol levels. However, talking to your doctor before taking any herbal supplements is essential, as they can interact with other medications and cause side effects.

If you are at risk for heart disease or have high cholesterol, it is important to discuss this with your health care provider. There are many individualized ways to manage cholesterol. If you have questions, make an appointment with a Columbia specialist.