Who Should Take Statin Drugs and When

Statin drugs are among the most commonly prescribed medications in the U.S. with annual sales of over $18 billion, according to research from the Northwestern University Feinberg School of Medicine in Chicago.

Statin drugs are known to significantly reduce the odds of having a heart attack or stroke by lowering the level of "bad" cholesterol in the blood. But they are no longer prescribed based solely on a person's blood test results. Today, statin drugs are used when has a person has a 7.5% or greater risk of having a heart attack or stroke over the next 10 years, or to patients who have known cardiovascular disease.

List of Approved Statin Drugs

Eleven statin medications are currently approved by the U.S. Food and Drug Administration, including four fixed-dose combination drugs. The seven primary drug agents are:

• Lipitor (Atorvastatin)
• Lescol (Fluvastatin)
• Mevacor (Lovastatin)
• Livalo (Pitavastatin)
• Pravachol (Pravastatin)
• Zocor (Simvastatin)
• Crestor (Rosuvastatin)

Low-cost generic versions are also available.

Benefits of Statin Drugs

Statin drugs lower cholesterol levels by inhibiting a liver enzyme, known as HMG Co-A reductase, which is key to cholesterol synthesis. The consistent use of these drugs is associated with a significant reduction in "bad" LDL cholesterol, a moderate reduction in triglycerides, and a small increase in "good" HDL cholesterol.

These effects translate to additional cardiovascular benefits, including:

• A reduction in the buildup of plaque on the walls of the arteries
• The stabilization of plaques so that they don't break off and cause an arterial obstruction in the heart or brain
• Decreased arterial inflammation as measured by the C-reactive protein (CRP) test
• Decreased blood clot formation at the site of an obstruction

These effects can also help reduce blood pressure, particularly in people with prehypertension who are not yet on blood pressure medication.

Common Side Effects of Statins

While statin drugs offer significant benefits to people at risk of cardiovascular disease, there may be side effects associated with their use. Most are mild to moderate in severity and typically resolve once the body adjusts to the treatment. The most common include:

• Nausea
• Gas
• Upset stomach
• Headache
• Dizziness
• Fatigue
• Rash
• Sleep disturbance
• Reduced concentration
• Muscle aches

Statins can also cause an elevation in liver enzymes in one of every 100 users. In most cases, this increase is not associated with serious or permanent liver damage, but care needs to be taken if statins are prescribed to people with underlying liver dysfunction.

Statins also appear to increase the risk of developing type II diabetes in some, most especially postmenopausal women.

Who Should and Should Not Take Statins

There has been some contention over the years as to whether statins are necessary or equally beneficial in all groups. This has been misconstrued by some as meaning that statins have no benefit and, worse yet, maybe harmful. This is not true.

In 2016, the government's U.S. Preventive Services Task Force (USPSTF) issued updated guidelines simply stating that the evidence was " insufficient" to recommend starting statins in people 76 and older who didn't have a history of heart attack or stroke. The American Heart Association and American College of Cardiology also reflect this update in their 2018 guidelines.

The statement by USPSTF was neither a rebuke of statins in this group nor a suggestion that people should stop taking their statin medications once they turn 76. Rather, it suggests that the benefits may be smaller and that clinical judgment needs to be made on a case-by-case basis.

The USPSTF further issued recommendations regarding the use of statins in the following risk groups:

• Treatment with low- to moderate-dose statins is recommended for adults 40 to 75 who haven't had a heart attack or stroke but are at risk of one. The determination is made based on whether the person has one or more ​risk factors for cardiovascular disease and a greater than 7.5% calculated risk of a heart attack or stroke in the next 10 years.
• Treatment may also be started, with clinical judgment, in adults of the same age group who have one or more cardiovascular risk factors and calculated risk between 7.5 and 10%.