Besides being some of the safest and most effective medications commonly prescribed, statins—the amazing drugs used to prevent heart attacks—are easy to take on a regular basis. You simply take one pill a day. Side effects are unusual. You can expect to see your blood cholesterol level start to fall within a few days of starting a statin, but it usually takes about a month to see the full effect. If you stop the medication, your cholesterol will return to its previous level in a few days.
The particulars of taking statin drugs go like this:
Statins are remarkably free of side effects, but you should know about possible consequences and understand what to do if they occur. Possible side effects are discussed below:
The muscle damage of rhabdomyolysis heals within a few days of stopping the medication. However, there have been a few cases in which severe muscle damage caused irreversible kidney failure. If you have already had an episode of rhabdomyolysis, you shouldn’t take these medications. There are alternatives.
How can you tell if a statin is causing your pains? Typically, statins make the legs ache more than the arms and shoulders. Exertion often worsens the discomfort, which is sometimes mistaken for poor circulation or arthritis. Statin-induced muscle aches usually come on shortly after starting or increasing the dose of a statin, although some people take the medication for months before noticing them.
You can have a blood test for statin-induced muscle damage called CPK. If you’re taking a statin and your muscles ache and your CPK is high—and everything returns to normal when you stop taking the medication—you probably have statin-induced muscle pain. Reducing the statin dose or switching to a milder one often solves the problem.
On the up side, studies indicate that statins improve osteoporosis, a weakening of bones that occurs with aging. Evidence that statins reduce the risk of type 2 diabetes and Alzheimer’s disease seem almost too good to be true. Studies are under way to examine these possibilities.
If you think you’re experiencing side effects to a statin drug, be sure they’re caused by the drug and not just coincidental. There are alternative medications, but none is quite as effective at lowering cholesterol as the statin.
Here’s what to do:
1. Stop the medication and see if the symptoms improve in a week or two. If not, the statin probably didn’t cause them.
2. If the side effects go away when you stop the pills, that doesn’t mean you should give up on the medication. If you can’t take it, you’ll miss out on the easiest, most effective treatment ever devised for preventing artery disease. So, for a week or two, take a break from the statins and then, under your doctor’s supervision, try taking them again.
3. If the symptoms return, you can assume the medication caused them, but don’t give up yet. Wait two weeks and switch to the lowest possible dose. If your side effects go away but the statin no longer lowers your cholesterol enough, your doctor can add a statin enhancer (see below), which will usually lower your cholesterol as well as will a full dose of a statin alone.
Small doses of other cholesterol-lowering drugs can increase the effectiveness of statins. If a full dose of statin doesn’t lower your cholesterol enough, or if you can’t take higher doses because of side effects, you may benefit from taking a medication to enhance its effects.
Statin-enhancing cholesterol-lowering drugs include the following:
The flushing that niacin causes usually subsides after a week or two. Start with a small amount—about 50 milligrams—and wait until the flushing subsides, then double the dosage. Over a period of two or three months, work your way up to 500 or 1,000 milligrams, which are the doses needed to produce a significant statin-enhancing effect.
All of these medications have modest cholesterol-lowering effects when taken alone, but none is as effective as statins are for lowering cholesterol and preventing atherosclerosis. Statins go right to the source of the problem—genetic defects in LDL receptor activity—and correct it. They are the mainstay of pharmaceutical treatment.
To put the safety of statins in perspective, you’re much more likely to experience serious side effects from aspirin. If you’re at risk for atherosclerosis and you’re not taking a statin, you are missing out on one of modern medicine’s most effective medications.