Cholesterol-lowering medicines, statins

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Overview

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.

LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver.

Why have I been offered statins?

Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels. It's the most common cause of death in the UK.

The main types of CVD are:

  • coronary heart disease – when the blood supply to the heart becomes restricted
  • angina – chest pain caused by reduced blood flow to the heart muscles
  • heart attacks – when the supply of blood to the heart is suddenly blocked
  • stroke – when the supply of blood to the brain becomes blocked

A doctor may recommend taking statins if either:

  • you've been diagnosed with a form of CVD
  • your personal and family medical history suggests you're likely to develop CVD at some point over the next 10 years and lifestyle measures (see below) haven't reduced this risk

Read more about when statins may be recommended.

Taking statins

Statins come as tablets that are taken once a day.

For some types of statin it does not matter what time of day you take it, as long as you stick to the same time.

Some types of statin should be taken in the evening.

Check with your doctor whether there's a particular time of day you should take your statin.

You usually have to continue taking statins for life because if you stop taking them, your cholesterol will return to a high level within a few weeks.

If you forget to take your dose, do not take an extra one to make up for it. Just take your next dose as usual the following day.

If you accidentally take too many statin tablets (more than your usual daily dose), contact your doctor or pharmacist for advice, or call 111.

Cautions and interactions

Statins can sometimes interact with other medicines, increasing the risk of unpleasant side effects, such as muscle damage.

Some types of statin can also interact with grapefruit juice.

It's very important to read the information leaflet that comes with your medicine to check if there are any interactions you should be aware of.

If in doubt, contact a GP or pharmacist for advice.

Find out more things to consider when taking statins.

Side effects of statins

Many people who take statins experience no or very few side effects.

Others experience some troublesome, but usually minor, side effects, such as an diarrhoea, a headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if they're offered to you.

The risks of any side effects also have to be balanced against the benefits of preventing serious problems. 

A review of scientific studies into the effectiveness of statins found around 1 in every 50 people who take the medication for five years will avoid a serious event, such as a heart attack or stroke, as a result.

Read more about the side effects of statins.

Alternatives to statins

If you're at risk of developing CVD in the near future, your doctor will usually recommend lifestyle measures to reduce this risk before they suggest that you take statins.

Lifestyle measures that can reduce your cholesterol level and CVD risk include:

Statins may be recommended if these measures don’t help.

Read more about treating high cholesterol and preventing CVD

Types of statin

There are five types of statin available via prescription in the UK:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol)
  • pravastatin (Lipostat)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)

Uses

Statins may be recommended if you have cardiovascular disease (CVD) or a high risk of developing it in the next 10 years.

Cardiovascular disease (CVD)

Cardiovascular Disease (CVD) is a general term for conditions affecting the heart or blood vessels,

It's often caused by high cholesterol and is the most common cause of death in the UK.

The main types of CVD are:

Statins cannot cure these conditions, but they can help prevent them getting worse or recurring in people who have been diagnosed with them.

They can also reduce the chance of CVD developing in the first place in people at risk.

Statins are usually used in combination with lifestyle measures such as:

People at risk of CVD 

If you do not have any form of CVD, statins may still be recommended if you're thought to be at a high risk of developing the condition in the future.

The current recommendation is that you should be offered statins if:

  • you have at least a 1 in 10 chance of you developing CVD at some point in the next 10 years
  • lifestyle measures, such as exercising regularly and eating a healthy diet, have not reduced this risk

A GP may recommend carrying out a formal assessment of your CVD risk if they think you may be at an increased risk of CVD, based on your personal and family medical history.

For this formal assessment, the GP or practice nurse will use CVD risk assessment computer software that takes into account factors such as:

  • your age
  • if you're male or female
  • your ethnic group, as some have an increased risk of CVD
  • your weight and height
  • if you smoke or have previously smoked
  • if you have a family history of CVD
  • your blood pressure
  • your blood cholesterol levels
  • if you have certain long-term conditions – such as diabetes, chronic kidney disease, rheumatoid arthritis and atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate)

Other uses

Statins can also be used to treat familial hypercholesterolaemia.

This is an inherited condition caused by a genetic fault that leads to high cholesterol levels, even in people who have a generally healthy lifestyle.

Considerations

Statins should not be taken if you have severe liver disease or blood tests suggest that your liver may not be working properly.

This is because statins can affect your liver, and this is more likely to cause serious problems if you already have a severely damaged liver.

Before starting to take statins, you should have a blood test to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and undergo another after 12 months.

Pregnancy and breastfeeding

Statins should not be taken by anyone who is pregnant or breastfeeding, as there's no firm evidence on whether it's safe to do so.

Contact a GP for advice if become pregnant while taking statins.

People at an increased risk of side effects

Statins should be taken with caution if you're at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. Severe myopathy (rhabdomyolysis) can lead to kidney damage.

Things that can increase this risk include:

  • being over 70 years old
  • having a history of liver disease
  • regularly drinking large quantities of alcohol
  • having a history of muscle-related side effects when taking a statin or fibrate (another type of medicine for high cholesterol)
  • having a family history of myopathy or rhabdomyolysis

If one or more of these apply to you, you may need to be frequently monitored to check for complications. A lower dose of statin may also be recommended.

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Read more about the side effects of statins below.

Interactions

Statins can react unpredictably with certain other substances (known as "interacting"), potentially increasing the risk of serious side effects, such as muscle damage.

Medications that can interact with some types of statin include:

  • certain antibiotics and antifungals
  • certain HIV medications
  • warfarin – a medication commonly use to prevent blood clots
  • ciclosporin – a medication that suppresses the immune system, which is used to treat a wide range of conditions, including psoriasis and rheumatoid arthritis
  • danazol – a synthetic hormone medication used to treat conditions such as endometriosis
  • verapamil and diltiazem – types of medication called calcium channel blockers, which are used to treat various conditions affecting the heart and blood vessels
  • amiodarone – a medication sometimes used to treat irregular heartbeats
  • fibrates – medications that, like statins, help reduce cholesterol levels in the blood

If you are taking statins and need to take one of these medicines, a doctor may prescribe an alternative statin or your current statin at a lower dosage. In some cases, they may recommend that you temporarily stop taking your statin.

Food and alcohol

Grapefruit juice can affect some statins and increase your risk of side effects. A doctor may advise you to avoid it completely or only consume small quantities.

The doctor will also ask you how much alcohol you drink before prescribing statins. People who regularly drink large amounts of alcohol are at increased risk of getting more serious side effects.

If you're prescribed a statin, you may be able to continue drinking alcohol. However, you should not drink more than 14 units of alcohol a week.

Researching your medicine

For full details of cautions and interactions relevant to your specific medication, check the patient information leaflet that comes with it.

If in doubt, contact a GP or pharmacist for advice.

Side effects

Like all medicines, statins can cause side effects. But most people tolerate them well and do not have any problems.

You should discuss the benefits and risks of taking statins with your doctor before you start taking the medicines.

If you are having problems with side effects, talk to the doctor in charge of your care. Your dose may need to be adjusted or you may need a different type of statin.

The main side effects of statins are listed here. Some of these will not necessarily apply to the specific statin you're taking.

For details of the side effects of a particular statin, check the information leaflet that comes with your medicine.

Common side effects

Side effects can vary between different statins, but common side effects include:

Uncommon side effects

Uncommon side effects of statins include:

Rare side effects

Rare side effects of statins include:

  • muscle weakness (myopathy)
  • loss of sensation or tingling in the nerve endings of the hands and feet (peripheral neuropathy)
  • tendon problems (tendons are tough cords of tissue that connect muscles to bones)

Muscle effects

It's rare, but statins can sometimes cause muscle inflammation (swelling) and damage. Speak to your doctor if you have muscle pain, tenderness or weakness that cannot be explained - for example, pain that is not caused by physical work.

Your doctor may carry out a blood test to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.

If there's a big increase in the CK in your blood, your doctor may advise you to stop taking the statin. Regular exercise can sometimes lead to a rise in CK, so tell your doctor if you've been exercising a lot.

Once your CK level has returned to normal, your doctor may suggest that you start taking the statin again, but at a lower dose.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you're taking.

It is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 06/03/2024 10:10:35