Why Statins Are Different From Other Cholesterol Drugs

Box of simvastatin and pill on table
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The main reason your doctor wants to lower your cholesterol is to reduce your risk of heart attacks and premature death from coronary artery disease (CAD).

And despite the fact that several classes of medications have been approved for lowering LDL cholesterol (LDL is the "bad" form of cholesterol), the only drugs that have been repeatedly shown to reduce the risk of heart attacks and premature death in people whose cardiovascular risk is elevated are the statins. In fact, large studies have even suggested that some of the non-statin cholesterol medications can worsen outcomes.

Currently, it is thought that statins are better than other drugs at improving outcomes because they have several beneficial effects in addition to their cholesterol-lowering capabilities. These "extra" effects may help to prevent the rupture of atherosclerotic plaques in the coronary arteries and may help to prevent acute coronary syndrome.

The Non-Cholesterol-Lowering Effects of Statins

The “extra” non-cholesterol-lowering effects of statins include:

  • An anti-inflammatory effect.
  • An anti-clotting effect.
  • A direct plaque-stabilizing effect.
  • A reduction in C-reactive protein levels (CRP)
  • An improvement in vascular function.
  • A reduction in dangerous cardiac arrhythmias.
  • Some regression (shrinking) of atherosclerotic plaques themselves.

These "extra" effects of statins may be as important (or even more important) than cholesterol reduction in improving outcomes.

For instance, these non-cholesterol effects may be the reason that giving statins during an acute heart attack provides an immediate clinical benefit — this is not a result you would expect if the only thing statins did was to reduce cholesterol. These non-cholesterol-lowering effects may also explain why statins can improve outcomes in certain high-risk patients whose cholesterol levels are not especially elevated to begin with.

Indeed, the unique benefits of statins have caused some experts to question the entire "cholesterol hypothesis" (the hypothesis that reducing cholesterol will reduce risk). These "heretics" believe it is not the reduction of LDL cholesterol that makes statins effective in improving outcomes, but the other effects of the statin drugs. So (they go on to suggest) maybe lowering cholesterol itself is not as important as we all think.

The Bottom Line

Either way, when your doctor recommends statin therapy as the best drug treatment for your elevated LDL cholesterol, she is simply demonstrating her knowledge of a substantial body of evidence suggesting that statins are uniquely beneficial.

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Article Sources

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  • Nissen, SE. High-Dose Statins In Acute Coronary Syndromes. Not Just Lipid Levels. JAMA 2004; 292:1365.
  • Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA Guideline On The Treatment Of Blood Cholesterol To Reduce Atherosclerotic Cardiovascular Risk In Adults: A Report Of The American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S1.