A first-line treatment for high cholesterol, statins help millions of US adults lower their risk for heart disease, heart attack, and stroke. Here’s what to know about this commonly prescribed medication class.

How do statins work?

We get cholesterol from two sources: diet and the liver. Statins interfere with the liver’s natural production of cholesterol. These medications are very effective at lowering levels of low-density lipoprotein (LDL) cholesterol — the type of cholesterol that accumulates in the walls of your blood vessels in high amounts, increasing your risk of a heart attack or stroke — and triglycerides, another type of blood fat.

Long considered to be primarily a cholesterol-lowering medication, statins are now associated with other heart health benefits. They are increasingly prescribed to lower the risk of heart disease for people with healthy cholesterol levels but other heart disease risk factors like high blood pressure or diabetes.

Before prescribing statins, a doctor will consider other key heart disease risk factors including blood pressure, weight, and diabetes.

Commonly prescribed statins

• Atorvastatin (Lipitor®)

• Fluvastatin (Lescol®)

• Lovastatin (Mevacor®, Altoprev®)

• Pitavastatin (Livalo®, Zypitamag®)

• Pravastatin (Pravachol®)

• Rosuvastatin Calcium (Crestor®)

• Simvastatin (Zocor®)

Side effects of statins

Some people experience side effects when taking these medications, with muscle pain as the most common. Other potential side effects of statins include:

• Increased blood sugar levels

• Constipation

• Nausea

• Diarrhea

• Stomach pain

• Cramps

• Elevation of liver enzymes

In most cases, side effects are mild and often resolve as your body adjusts to the medications. Your doctor may order tests on liver function, but liver abnormalities are rare. Statins are not safe to take if you are pregnant or breastfeeding, or if you have chronic liver disease.

Interactions

Some medications, including statins, work less effectively when mixed with certain foods and beverages or other medications in what is referred to as a medication interaction.

Statin interactions with food and drinks

Grapefruit and grapefruit juice can block the enzymes your body needs to break down statins, leading to higher blood levels of the medication and a greater risk of side effects.

Some statins like atorvastatin, lovastatin, and simvastatin interact more strongly with grapefruit and grapefruit juice, while fluvastatin and pravastatin are less affected. If you have concerns about this potential medication interaction, speak with your doctor about your options.

Statin interactions with other medications

Other medications can also impact the effects of a statin or increase the risk of side effects. These include but are not limited to:

• Amiodarone (Pacerone®), a heart rhythm medication

• Gemfibrozil (Lopid®), another cholesterol medication

• Some protease inhibitors used to treat HIV and hepatitis C, including boceprevir and telaprevir

• Some antibiotics, including clarithromycin, erythromycin, and telithromycin

• Some antifungals, including itraconazole, ketoconazole, nefazodone, posaconazole, and telithromycin

• Some immunosuppressants

To avoid a negative interaction when taking a statin or another medication, make sure that all of your prescribers are familiar with your health history. They should be informed of all medications you currently take, both prescription and over-the-counter.

It’s also best to consolidate all of your prescriptions at a single pharmacy. At Alto, we check for potential interactions when receiving a new prescription by reviewing all the medications we have on file.

Alternatives to statins

Each person’s response to medication is unique. If you experience side effects or cannot take statins for another health reason, there are other cholesterol-lowering medications to consider, including:

• Ezetimibe (Zetia®), a cholesterol absorption inhibitor and the most commonly used non-statin cholesterol medication

• PCSK9 inhibitors such as alirocumab (Praluent®) and evolocumab - administered as injections every 2-4 weeks

• Niacin (nicotinic acid)

Ezetimibe and niacin can also be used in combination with statins.

There are also alternatives for people who take statins to lower triglycerides, like fibrates. Commonly prescribed medications from this class include gemfibrozil (Lopid®) and fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide®).

The pharmacy care you deserve

At Alto, we make it as simple as possible to stay on track with your cholesterol-lowering medications. We offer same-day delivery and medication management tools like reminders and auto refills in our app. And our expert pharmacists are always just a message away!

To learn more, reach out via in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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