The world’s best-selling medicine is Lipitor (atorvastatin), a statin drug that lowers the amount of cholesterol produced by the liver. Statins work by blocking a specific enzyme, hydroxymethylglutaryl-coenzyme A reductase, that is involved in cholesterol synthesis.

High total cholesterol is considered anything greater than 200 milligrams per deciliter. It’s also considered problematic if your overall number is below 200 but your LDL, or “bad” cholesterol, is higher than 130. For someone who is overweight or who smokes, doctors may even consider total cholesterol levels as low as 180 to be undesirable.

Some people can control cholesterol levels with exercise and diet. For those who can’t, doctors may prescribe statins. These medications are usually taken for life: Once a person stops taking them, his or her cholesterol levels will probably go back up.

Studies have shown that statin drugs can lower LDL cholesterol by 20 to 60 percent, usually within 4 to 6 weeks. They have also been shown to reduce triglycerides and the level of C-reactive protein—a marker of inflammation and heart disease risk— and produce a modest increase in the levels of HDL, or “good” cholesterol. Usually, these results mean large reductions in heart attack and heart disease risk.

Statins also seem to be associated with a lower risk of certain kinds of cancer, blood clots, and other health problems, although long-term studies are still needed to confirm these claims. Dementia, specifically, is an area of much controversy: Some researchers claim that statins appear to prevent the onset of cognitive decline, while others suggest that taking a statin has actually caused confusion or memory loss in patients.

More than 25 million people worldwide take at least one of the following statins: atorvastatin, simvastatin (Zocor), rosuvastatin (Crestor), pravastatin (Pravachol), lovastatin and lovastatin extended release (Mevacor, Altoprev, and Altocor), and fluvastatin (Lescol). These medicines differ in potency and the amount of cholesterol production they inhibit and range from about $35 to $140 a month for brand-name drugs. Some medications pair statins with other types of cholesterol-lowering drugs: Vytorin, for example, combines simvastatin with ezetimibe, a cholesterol-absorption inhibitor.

ADDITIONAL FACTS

  1. Statin use can cause a deficiency of the nutrient coenzyme Q10, which can lead to muscle aches, cramping, and, in rare cases, a severe form of muscle fatigue called rhabdomyolysis. In 2001, Bayer HealthCare Pharmaceuticals voluntarily withdrew the statin drug cerivastat in (Baycol) from the market following reports of fatalities due to this condition.
  2. Eating grapefruit or drinking grapefruit juice while taking many types of statins can cause dangerous complications, and doctors often recommend that people taking statins avoid the fruit.
  3. People who use statins should not take large amounts of niacin supplements without consulting their doctors.