For many people, lifestyle changes on their own are not enough to bring their high cholesterol down to a healthier level to lower the risk of heart disease. Many people will need to take statins, the main type of cholesterol-lowering drug.
What are statins?
Statins are a type of medicine that are used to lower the cholesterol in your blood, helping to prevent heart disease and stroke.
Statins often work very well. They can reduce your LDL cholesterol by around 30%, sometimes even 50% with high doses.
You might be offered a statin if you have too much LDL-cholesterol (bad cholesterol) in your blood - whether it’s caused by your lifestyle or by genetic conditions which are passed down through families.
Like all medicines, statins can sometimes cause side effects. They usually don’t cause any, but if you do have side effects, it should be possible to switch to another statin or a lower dose, or try a different medicine.
Statins have been around for a long time and they have been changed and improved over the years.
How do statins work?
Statins work by slowing down the production of LDL-cholesterol in the liver, where it’s made. Because the liver isn't making so much cholesterol, it then takes cholesterol out of your blood to make bile with, so your blood cholesterol levels fall.
Statins slow down LDL-cholesterol production by blocking an enzyme called HMG-CoA-Reductase – the medical name for statins is HMG-CoA Reductase inhibitors. Enzymes are proteins in the body which speed up normal processes. In this case, LDL production.
Statins can lower your triglycerides
As well as lowering your LDL-cholesterol, statins can lower your triglycerides too, and high triglycerides are linked to liver disease, heart disease and diabetes.
Statins can raise HDL cholesterol
Statins can sometimes raise your HDL-cholesterol – the type of cholesterol which helps to clear the fat from of your arteries, but their main effect is lowering LDL cholesterol.
Who can take statins?
You might be prescribed a statin if you have heart disease or another disease of the heart and blood vessels, or if you are at risk of developing them in the next 10 years.
If you have high cholesterol
You should be offered a statin if you have high cholesterol and lifestyle changes haven’t been enough to bring it under control.
Depending on your cholesterol levels and how healthy you are otherwise, you and your doctor or nurse might want you to try to bring your cholesterol levels down with a healthy diet and lifestyle first, before starting statins.
If you are at risk of developing heart disease
You will probably be prescribed a statin if you are at high risk of developing heart disease or a disease of the blood vessels. For example, if you have:
- kidney disease
- high blood pressure
- people in your family have died from heart disease.
You doctor will take lots of things into account to get an idea of your risk of developing diseases.
If you have been diagnosed with heart disease
You will probably be offered a statin if you already have a disease of the blood vessels, for example:
- peripheral arterial disease (PAD) or poor blood circulation
- coronary artery disease, where the blood vessels leading to the heart have become narrowed
- heart attack, where the blood supply to the heart is cut off
- stroke, where the blood supply to the brain is cut off.
Statins can stop your illness from getting worse. And if you have already had a heart attack or stroke, they can help prevent another one.
If you have a genetic condition
You might be offered a statin if you have high cholesterol caused by a genetic problem such as familial hypercholesterolaemia (FH).
Statins help to stabilize the fatty, hardened parts of the arteries, known as plaques. Plaques can form when you have high cholesterol or other problems such as high blood pressure or diabetes.
These hardened areas are usually unstable, meaning that they can burst. When they do, they release chemicals that cause blood clots to form. The blood clots can block the artery or bits can break off and block a blood vessel in another part of the body, cutting off the blood supply.
This is why you might be prescribed a statin if you have health problems that mean you’re at risk of a heart attack or stroke, even if you don’t have high cholesterol.
There are five types of statins in the UK.
If you start taking statins, you’ll need to keep taking them in the long term – as your cholesterol levels will rise again if you stop taking them.
They come as a tablet which you will need to take once a day. They should start to work within two to three months.
You should have check-ups with your doctor or nurse and have blood tests to see how well your statins are working. This is usually after three months. You will have a cholesterol check to see if your cholesterol level has changed, and a liver function test to see if your liver is healthy.
It is recommended that you have these tests again a year later to keep any eye on your cholesterol and liver.
Statins can sometimes interact with other medicines and cause side effects. Talk to your doctor about any other medicines you’re taking before you start taking statins to make sure they’re suitable for you.
Getting the most from your statins
- Take your statins every day to keep your cholesterol levels down.
- Take them at the same time every day.
- Your doctor or nurse might suggest you take your statins at night, before you go to bed. That’s because the liver is more active in making cholesterol at night. This is except for atorvastatin and rosuvastatin which you can take at any time.
- If you forget to take your tablet, carry on as normal the next day. Don’t take an extra one to make up for it.
- Avoid grapefruit juice if you are taking simvastatin, and no more than one or two small glasses of grapefruit juice if you are taking atorvastatin.
- Speak to your doctor if you are struggling with your statins, for example, if you’re having side effects. Don’t simply stop taking them because your cholesterol will go back up again. There’s usually a very simple solution, such as trying a different statin or a lower dose.
- Keep looking after your health by eating healthily, being active, watching what you drink and stopping smoking if you smoke. Statins can lower your cholesterol but they will work better if your lifestyle is healthy too. Plus, you’ll be looking after your body as a whole, lowering your blood pressure, your weight and your risk of health problems.
Are statins safe?
It is quite understandable to have questions if you need to take a new medicine. Statins are the most widely used medicine to lower cholesterol and they have been around for a long time. There have been a lot of news stories about them which sometimes puts people off taking them.
We are often asked if statins are safe and if there are any side effects. It's up to you whether you start taking them or not, so we've put together some answers to common questions to help you decide.