Stephen Kopecky, M.D., a Mayo Clinic physician specializing in preventive cardiology, describes ways to lower LDL (bad) cholesterol without taking prescription drugs called statins.
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What Is Believed To Be Qualities Of All Statin Medications:
Statins are a class of medications specifically prescribed to lower LDL- one of five lipid parameters of a person’s lipid profile, which is alto the name of the blood test to measure these parameters. They are known as statins, as all of these types of medications end with the letters, statin.
There are about 6 available statins to choose for lipid management as needed- with three that are combination drugs that have a statin included in these drugs.
There are other classes of medications for lipid management, such as bile acid sequestrants and nicotinic acid, which is known as niacin. Yet the side effect profile is more unfavorable of these classes of medications compared with the statin class of drugs.
One’s cholesterol level is primarily due to how they produce cholesterol in their liver, which is overall genetically determined. This level is also determined by one’s lifestyle and diet as well. If a person has too much cholesterol in their blood, it can lead to hardening and narrowing of their arteries as well as the formation of coronary plaques in the coronary arteries.
If these plaques break off of the arterial wall, this leads to a myocardial infarction, or heart attack. Statins are believed to stabilize coronary plaques so this does not occur.
To measure one’s cholesterol, a blood test called a lipid profile is obtained from a person after they have fasted for at least 12 hours. The test should also be performed only if the person is free of any acute illness, as this may affect true lipid measures.
If the results prove to be abnormal, lipid altering medicinal therapy may be initiated- according to the discretion of the person’s health care provider. This therapy usually involves a statin medication.
Adverse events associated with the statin class of pharmaceuticals are thought to occur more often than they are reported- with high doses of statins prescribed to patients in particular at times that may not be necessary to control their dyslipidemia based on their lipid profile. Side effects may include muscle pain, or possible damage to the patient’s liver.
However, since this class of statin drugs has existed for use for over 20 years, statins are considered to be overall safe and effective for enhancing the clearance of LDL noted to be elevated in the lipid profiles of patients.
Also, they have proven to reduce cardiovascular mortality with one who is treated with a statin that has dyslipidemia. In addition to lowering LDL by up to about 60 percent- depending on the choice of the statin prescribed for the patient, and how high the LDL cholesterol is in a patient.
This class of drugs also has the ability to raise their HDL lipid parameter as well as lower to their benefit their triglyceride parameter of their lipid profile. Both of these additional effects in addition to lowering the LDL parameter from taking a statin drug is ultimately beneficial for the patient on a statin drug for lipid management.
Statin therapy is also recommended for those patients who have a greater than twenty percent risk of developing cardiovascular disease, or those patients that have clinical evidence of this disease.
Additionally, there appears to be no comparable reduction in cardiovascular morbidity or mortality, as well as a difference in the increase of one’s lifespan, if one is on any particular statin medication for their lipid management over another, others have concluded. So caution should perhaps be considered if one chooses to prescribe a statin for a patient if they are absent of, or have only mild dyslipidemia to a significant degree.
Furthermore, research should be done by the health care provider if they are under the belief that one statin medication provides a greater cardiovascular benefit over another. In other words, the health care provider should be assured that any choice of statin therapy for their patients is considered reasonable and necessary if the LDL in their patients need to be reduced, and the statin selection should be determined by the results that have been shown with a particular statin.
There exist abstract etiologies for health care providers at times to choose to prescribe statin drugs on occasion for reasons not indicated with the medicinal treatment of these statin drugs. Examples include the speculated benefits associated with statins- such as reducing CRP levels, or for Alzheimer’s treatment, or other reasons not directly related to cholesterol management.
Statin therapy for such patients may not be considered appropriate, reasonable, or necessary prophylaxis at this point for any patient who does not have the indications for which statins are approved for to treat patients with dyslipidemia. All other benefits that appear to have favorable effects in such areas not involved with a patient’s cholesterol are suggested at this point due to minimal research in these other variables aside from lipid management.
Other reasons for placing a patient on a statin drug at this time require further research for these disease states and dysfunctions that may exist with a patient aside from dyslipidemia.
Statins as a class of drugs seem to in fact decrease the risk of cardiovascular events significantly, it has been proven. Statins also decrease thrombus formation as well as modulate inflammatory responses (CRP) as additional benefits of the medication.
For those patients with dyslipidemia who are placed on a statin, the effects of that statin on reducing a patient’s LDL level can be measured after about five weeks of therapy on a particular statin drug.
Liver Function blood tests are recommended for those patients on continued statin therapy, and most are chronically taking statins for the rest of their lives to manage their lipid profile in regards to maintaining the suitable LDL level for a particular patient presently. Patients should be made aware of potential additional side effects as well, such as myopathy and muscular dysfunctions that occur on occasion when one is on statin therapy.
Yet some have said that about half of all strokes and heart attacks that do occur are not because of increased cholesterol levels of these patients. So it appears clear that high cholesterol may not be an absolute for cardiovascular events for them to occur.
Others believe that it is oxidized cholesterol that causes vulnerable plaques to form on coronary arterial walls, which is the catalyst for a heart attack, and that there is no medicinal treatment for the formation or stabilization of these plaques to prevent heart attacks or strokes.
Some who support statin medicinal therapy for their clinically appropriate patients claim that these drugs, do, in fact, stabilize these plaques as an added benefit, and therefore are beneficial.
As stated previously, in regards to other uses of statins besides just primarily LDL reduction, there is some evidence to suggest that statins have other benefits besides lowering LDL, but not enough evidence yet.
These other disease states include aside from what has been stated already, such as those patients with neurological disease, as well as statins being beneficial for certain cancer patients. Some have suggested that statins interfere with cancer treatment with bladder cancer patients as well. Yet again, these other roles for statin therapy have only been minimally explored and researched, comparatively speaking.
Because of the limited evidence regarding additional benefits of statin medications, the drug should again be prescribed for those with dyslipidemia only at this time involving elevated LDL levels as detected in the patient’s bloodstream.
Yet overall, the existing cholesterol lowering recommendations or guidelines should possibly be re-evaluated. The cholesterol guidelines that presently exist may be over-exaggerated possibly due to tacit suggestions from the makers of statins to those who create these current lipid lowering guidelines.
This is notable if one chooses to compare these cholesterol guidelines with the other guidelines that have existed in the past. The cholesterol guidelines that exist now are considered by many health care providers and experts to be rather unreasonable and unnecessary, as well as possibly have the potential to be detrimental to a patient’s health.
Yet statins are beneficial medications for those many people that exist with elevated LDL levels that can cause cardiovascular events to occur because of this abnormality. What that ideal LDL level is may have yet to be empirically determined.
Finally, a focus on children and their lifestyles should be amplified so their arteries do not become those of one who is middle-aged, and this may prevent them from being candidates for statin therapy now and in the future, regarding the high cholesterol issue. Treating children with a statin drug for dyslipidemia is controversial presently. Dietary management should be the first consideration in regards to correcting lipid dysfunctions that may exist in patients.
http://www.americanheart.org
Dan Abshear
I have taken statins since 1986. I had my first bypass at age 45(1985)
second at age 51. nothing since. I have been fortunate. I have
recently had to stop taking the statin. My my muscles in arms\and
lets were hurting to the point that i could not move. had problems
before but not to this point. i hate to stop taking the statin.
What choice do I have. Unfortunately I have to stop taking the
statin or I will be crippled. Always before I would stop taking
for about 2 weeks and would feel better. not this time. still having
problems with arms. still weak. PLEASE HELP.
Ms. Thompson, Thank you for your message. Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices at 800-446-2279 in Arizona, 904-953-0853 in Florida or 507-538-3270 in Minnesota. I hope this information is helpful.
I’m a 59 year-old male who has been on statins for about 15 years. I’ve done Pravachol, Zocor, Crestor, and am presently on Lipitor (40 mg). Why the range of meds? Because sooner or later, I’ve developed muscle pain in my legs (and elsewhere). In the past few months, the pain has gotten much worse. It’s ironic: I joined a gym in January to improve my health, but the resulting leg pain has been troubling. I’ve heard it all…stretch, get new athletic shoes, slow down your routine, etc. But to me, the truth seems to be that statins are playing a role. I am about 40 lbs. overweight (5’10, 220 lbs.) and have been losing weight, but the pain seems to go beyond any “getting used to exercise” time period. Yesterday, my wife and I strolled for two miles and by the evening, I couldn’t find a comfortable position for my legs.
My questions is this: my doctor has recommended that I cease the Lipitor for a week. I have and have seen little difference, but is a week long enough? I understand his concern; I have three cardiac stents (90% blockage 3 years ago, so I know statins are no guarantee that nothing can ever happen while you’re on them). Any suggestions?
Dr. Kopecky suggests you stop the drug for 2-4 weeks, and if it’s due to the drug, it should get better in that time frame. If no better, restart it. If better or resolved , then would try another (lovastatin) or go down to a lower dose that is tolerated in that it is better to be on some statin than none.
I have CAD with one stent after going through angioplasty in jun 2010.I am 59. my ldl is 45 and total cholestrol 115, non diabetic and normal BP. weight 150lbs and height 5ft 10in. I am on PLAVIX 75mg and LIPIGET 40mg. for the past almost 20 yrs i am suffering from leg pain specially CALF area and acute burning feet. Despite consultations, doctors have not been able to diagnose. Nerve conduction ok.Left kidney disfunction. serum cretinine 1.4. Apparently no other problem.
PLEASE HELP
Thanks for your interest. Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations here. If you would like to seek help from Mayo Clinic, please call our appointment office in Arizona at 480-301-1735; Florida, 904-953-0323; or Minnesota, 507-284-2511.
April 2011 CMP–Sodium low @129, Aspartate Amino-Trans low @10, Cholesterol high @254, Triglyceride @l09, HDL @44, LDL high @188. On Zorcor in late 80s. Kept in ER overnight on IV for muscle weakness and told never to take a statin again. Now four different cardiologist want me to take 10 mg. of Prevochol but to quit at the first sign of muscle pain. Filled the script but darned near had a panic attack w/the thought of taking it. Becoming austere w/diet. Always exercised vigorously but have some back limitations now. Is dextrin a substitute for metamucil? Thanks for any suggestions and your good work. gfk 5’4″ & 145#s
Genevieve, Thank you for your note but unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to be evaluated at Mayo Clinic, please call one of our appointment offices. The numbers can be found at mayoclinic.org.
Are there statistics available on the Web showing the efficacy of statins for people who have had a heart attack?
I ask because, although the claim is repeated on innumerable Web pages, I’ve never seen the evidence. I’ve looked at results, for example, for the JUPITER trail, which involved people with high levels of c-reactive protein. All the studies I’ve seen seem to include special classes of people – high crp, high levels of LDL, low HDL, etc.
What about studies that show the benefits of statins on people, like me, who have normal cholesterol, normal crp, etc?
So, what study would let me assess the reduction in risk of another heart attack if I take a statin.
I have read that high doses of Vit c also can lower Cholesterol. Are you aware of any studies that support this?
We have received your question and will check on the answer.
Studies have not shown that vitamin C is helpful in lowering cholesterol.
I had been on Lipitor and Lovistatin, up to 40 mg. The effect on my blood panel was to lower LDL. but also HDL to low levels. If statins are meant to lower LDL, what significance, if any, is to be given to their tendancy to also lower HDL? Total Chlorestol was about 114, as I recall. This was three years ago at age 61. What should I ask a doctor?
Bruce, we have forwarded your question.
Bruce, the first statins to come out such as lovastatin and pravastatin tended to lower HDL by small amounts. Some of the more recent statins such as rosuvastatin and atorvastatin may actually raise it small amounts. Of course there are variable responses within different patients, and you may have had a more pronounced response with more lowering of your HDL than the average person.
What is the effect of this?
Answer: If you lower your LDL or raise your HDL, both of these are beneficial in that they reduce your chance of having a heart attack. Next time you visit with your doctor, you can ask his or her advice regarding going on one of the newer statin drugs mentioned above which may actually raise your HDL.
After discontinuing statins, how long should it take for the hurting muscles and stiffness to go away? Also, how effective is taking fish oil for lowering cholesterol? Doctor suggested taking 3, 1000mg daily.
We are forwarding your questions for a reply.
After stopping the statins the muscle aches should go away in 2-4 weeks. If they do not, it is unlikely it was caused by the statin.
How effective is taking fish oil for lowering cholesterol:
Answer: Fish oil does not lower cholesterol per se, but higher dose fish oil such as 3-6 grams per day of EPA and DHA can lower triglycerides which is one of the lipids we test for commonly in the blood.
I developed Neurothapy in my thigh about 25 years ago but mainly only had numbness with a little burning sensation. I started taking Simvastatin about 5 years ago. Recently, I began experiencing shooting pains in my thigh mainly when I stand more than 5 minutes. My question is, can taking the statin drug cause the symptoms of the Neurothapy to accelerate? My doctor has prescribed Norotriptiline for this leg pain but so far, it hasnt helped. I would like to stop the statin and try weight reduction (5′ 2″. 175 pounds) and .excersize. Are there other ways to reduce cholesterol besides statins and Niacin?
These stories are frightening. My Dr. wants to put me on Statins and the more I read the more I become convinced that it may not be a good thing. Everyone…and, I mean “everyone” I talk to seems to have the same issues associated with prolonged use of Statins. Even my own Dr. told me he had to switch Statins twice because of back and muscle pains…YIKES! Now he wants me on the stuff! They FDA took the cholesterol lowering drug out of Red Yeast Rice, thus removing one of the safest alternatives to statins. I’m going to drop 25 lbs asap and get tested again.
I took Zocor for about 15 years, I have had severe leg cramps for probably 10 years or more. Also cramps in my feet. My husband is undergoing treatment for the past 4 years for Multiple Myeloma and I am now required to drive all of the time. There has been many times that I have had to stop and get out and work a cramp out of my leg or feet. They were terrible at night, and I seldom got a good nights sleep. I was changed to Pravastatin, still the same problem. The druggist with our drug company told me to stop it and take Niacin, but my family doctor said, don’t take Niacin. My Cholesterol stayed at 147 for years on the zocor. My last reading was 230. Seeking alternative.
I have had by-pass surgery and i am on Lipitor. After some years of taking Lipitor i have started losing my memory.
I have been on simvastatin for about 10 years; have had three occurances of multiple high grade bladder cancer tumors in less than 6 months with one round of BCG treatments in that period. With this progression, worth trying substituting another med for the statins with the hope the BCG works better next time?
Unfortunately, We cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. Appointment information can be found at mayoclinic.org.
I am a 56 year old male with type 1 diabetes, 5’9″, 177 pounds. I also have a history of CAD with a stent in the LAD 6 years ago. I exercise daily and am physically in pretty good shape. I have not felt well on various statins since the stent and have been off of them for about 6 months. My most recent cholesterol was 213 with HDL at 75 and LDL at 124. My endocrinologist really wants me on a statin to bring my LDL down but I’m not convinced I should. I have recently read about the possibility of increased chances of cardiomyopathy associated with statin use. Are you aware of anything other than anecdotal evidence? With heart issues already, I’d rathet not subject myself to problems.
This is a good question about cardiomyopathy and statin use. It has been shown that statins can lead to muscle aches of skeletal muscle, but there is no good evidence that it causes problems with heart muscle. This is important to know since heart muscle is very different than skeletal muscle in its architecture and makeup. The likelihood of you having more problems with your arteries to your heart narrowing are much greater than any problems you would have from taking a statin and its side effects. I would agree with your endocrinologist that a statin would be a good idea. Try to work with him or her to find one that you can tolerate.
Sincerely,
Stephen L. Kopecky, M.D.
Mayo Clinic
Department of Internal Medicine/Cardiovascular Diseases
Is there a ststin that has lower risk of inducing liver damage over others. I took Lipitor(r) and had mild increase in liver enzimes. I shifter to weight reduction and exercise but still my LDL readings are high.
Thank you.
Jaime, Thanks for the question. We’ll forward it on and hopefully have an answer for you.
Jamie, Here is the reply from Dr. Kopecky:
The statins can all cause a rise in liver function tests, but none of them are any better or worse in general than the other. If your liver blood tests went up on Lipitor then you could try another agent such as generic pravastatin or simvastatin to see if you have the same response. They all have slightly different ways of being metabolized by the liver and one of these other generic drugs may be better for you to try, under your doctors supervision. Even if it does cause some mild elevation of your liver blood tests, it would be worthwhile trying to stay on a lower dose that may not get your LDL as low as your doctor would like it to be, but it is better than no treatment.
I am 37 years old, LDL 170 and total 270. I have tried several times to go on simvastatin, but the Musce pains are unbearable, and it seems each time I go off them my cholesterol is higher than when I started taking them. Is it dangerous to go on and off statins, and is it true that doing that can actually increase your cholesterol?
Going on and off statins has not been shown to cause any rebound problems or an increase in cholesterol. However, it can be difficult to take the statins if you develop muscle aches, but all statins in patients are different, so it may be worthwhile speaking with your caregiver about alternate statins to try – there are now multiple readily available generic statins that are inexpensive and very effective.Steve Kopecky, M.D.
I am 58 female. Take 10 mg lipitor for 8. Years. Chorlestoral runs 200. 5’3″ 155 lbs. 8 years ago heart cath…found nothing. Lipitor precaution. Family history. Foot and shoulder problems started year ago. Previously very active, gym 2x week and trainer. now non-active. Now experiencing night sweats, mainly stomach and back. Would like to go off statn drug.
I have been on 20MG of simvastatin for the past few years. I also have parkinson’s. I was developing crippling pain in my lower back and thighs to the point where when I got out of bed in the morning I could not walk erect. I originally thought it was Parkinson’s. After researching the side effects of simvastatin I stopped taking it. The pain was gone within 5 days. My doctor is concerned that if I don’t take a statin I will have a stroke or heart attack. Is there a statin that is significantly chemically different from simvastatin that I could try. Other side effects also reduced or totally eliminated when I stopped the simvastatin were the swelling my fingers, ankles, and feet when I was physically active.Which is every day.
We have received your question and are checking.
There are 7 statins currently approved for use in the US and they are all chemically different. Would suggest you contact your primary caregiver to try another Statin as suggested – and this time you know what symptoms to look for.
I have read that statins have been shown to increase insulin resistance, which contributes to chronic inflammation, and, of course, cause diabetes. Also, shouldn’t I be taking CoQ10 if I take a statin? And how much do docs still rely on the Jupiter study when the data set appears biased?
We have received your question and are checking on an answer.
I took Vytorin 10/20 for about 20 months. I have always been fairly athletic but getting out of bed was a chore. I was unable to move without joint/muscle pain and was feeling like an old arthritic. I was switched to simvistatin and the joint pain left but after about 8 months realized that on a general feeling-good scale of 1-10 I was living around a 5. Just concentrating and getting through each day was a struggle. At 5’8″, 153 lbs, normal blood pressure. LDL is at 197, HDL 93 (280 combined) triglicerides 158. We eat fresh fruit & vegatables, fish, chicken (baked) and little red meat, very little packaged foods, don’t smoke and drink very little alcohol and exercise regularly (used to be a runner).
My doctor wants me to try more statins. I see it as an expensive way to lower my cholesterol AND feel miserable, a pretty poor choice. I can live a little longer but can’t work, get out of bed or pick up my grandchildren. Such a deal.
Suggestions?
Will, thanks for writing. We’ll forward your question.
Will,
In general, Dr. Kopecky says there are a few things that you can talk with your doctor about. They include:
1 stop all statins and wash out for at least 4 weeks to see if all symptoms go away
2 check for other medicines that can interact with simvastatin and make side effects
3 check vitamin d levels – if low, the muscle aches can improve with replacement therapy
4 try coenzyme Q10 – supplements are usually suggested to be ubiquinol 200 mg twice a day and take for ~ 3 months to see if they help
5 if feeling better, or pain free, would try a low dose of another statin , like atorvastatin 10-20 mg and if symptoms recur then stop
6 finally, a less than daily dose of rosuvastatin 5 mg ( maybe 1 or 2 x a week ) is often tried to see if tolerated . May have to accept a higher than ‘goal’ LDL
If none of the above help, then an option may be some of the newer ‘non-statins’ that lower LDL –they are being used only in research studies but we have one study going and another will start up in a couple of months.
Of course all situations are different, and always consult with your own physician before taking any steps.
Good luck.
I was on Lovastatin for 8 years. I was cycled through a pain program three times. I was considered a pain for the doctors because they were unable to see much wrong with me. I asked many times if it could be the medicine and was told my liver tests were fine. My ferritin at one point was down to 8 and I had such a bad reaction to supplements, work wanted to send me out in an ambulance. The doctor wanted to start me on a new statin so I stopped taking the old one for a few days. My pain started to slack off and after a few weeks I could walk up a flight of stairs for the first time in years. My ferritin was dumping again so they wanted to check where my ferritin was going. An invasive check of my insides was set up, both top down and bottom up. My blood test showed in less than 2 months my ferritin had gone up by 5 points even cutting out most meat, just eating small amounts of fish and chicken. I almost canceled the day of the procedure. They found the bad kind or polyps, one was precancerous along with my throat. The polyps were removed and we will watch the throat. It doesn’t seem the dropping ferritin was from the problems found in my colon or stomach but they will be watched. I’m glad that the problems were found before they could get so much worse. I just wish the doctors didn’t rely on what works for normal and pay attention to what the people who they are treating say. When I stand up for myself I am treated as a problem. My massage therapist who specializes in trigger point therapy could tell the difference in me in less that two weeks after stopping the statin. My cousin and aunt both have problems with muscle pain from statins. I’m grateful I only have the pre cancerous changes in what was found. I gained a full person in weight and I’m not a big eater. I’m now loosing weight without any real effort other than I cut out pork and cheese. My cholesterol has gone up but I’m hoping that will change as I get this weight gone. I also had strange fat deposits, one was removed during ankle surgery but was returning, they are dissipating. I’m really angry that I was ignored for so long and left on something that seems like it was killing me. I think my ferritin was dropping because my immune system was attacking the red blood cells but I don’t know for sure. i do wonder if my ferritin would of rebounded so fast before the procedure if it wasn’t the statin. I’m not looking for anything from you guys except I don’t think doctors are aware of problems like this. Having 3 in one family that we know of probably makes it genetic. How do I communicate with the strong personalities necessary to be a doctor without scaring them. I’m kinda abrasive after years in law enforcement street and jail. I’m not good with the one size fits all attitude. I have a lot of sensitivities to things and they seem to run in the family. I also have no desire to die. I guess I’m looking for choices I can present to make the situation better. I know you have limitations in this forum but Im not expecting miracles. Statins aren’t one size fits all.