It may seem like high cholesterol isn’t a big deal—after all, more than 102 million Americans over the age of 20 have a total cholesterol level that’s over the normal range (200 mg/dL), according to the Centers for Disease Control and Prevention (CDC). Even worse, approximately 35 million of those adults have levels of 240 mg/dL or higher, which puts them in the danger zone for developing cardiovascular disease. Just because it’s common, doesn’t mean you can ignore it if yours measures above healthy levels. It’s very important to understand and manage your cholesterol—potentially by using a treatment like statins.
What is cholesterol?
Cholesterol is a waxy substance that comes from the liver (the body naturally makes it) and from your diet (it’s found in animal food sources, such as meat, eggs, and full-fat dairy). Cholesterol circulates through the bloodstream and is necessary for several bodily functions, including the production of hormones, vitamin D, and cell membranes. However, an excess of cholesterol in the blood—namely low-density lipoprotein or LDL cholesterol—can stick to the walls of the arteries and turn into plaque.
“Plaque in our arteries can block blood flow and promote clot formation, which leads to heart damage (for example, a heart attack) and brain damage (a stroke),” says Joshua Yamamoto, MD, cardiologist, co-founder of Foxhall Medicine in Washington, D.C., and author of You Can Prevent a Stroke. “In fact, plaque growth is not a disease [called hypercholesterolemia]—it is natural biology, the effect of time and age on our circulation.”
What are statins?
Statins, a class of drugs that lower cholesterol, have become the gold standard for treating hypercholesterolemia, explains Dr. Jennifer Haythe, MD, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center. In fact, more than 11.6 million American adults are currently taking statin drugs for atherosclerotic cardiovascular disease (ASCVD), according to statistics from the latest National Health and Nutrition Examination Survey.
Popular statins include:
- Crestor (rosuvastatin)
- Lipitor (atorvastatin)
- Zocor (simvastatin)
- Pravachol (pravastatin)
- Altoprev or Mevacor (lovastatin)
- Lescol (fluvastatin)
- Livalo (pitavastatin)
How do statins work?
“Statins work by not only blocking the enzyme that produces cholesterol, but also by helping the body reabsorb existing cholesterol,” Dr. Haythe explains. Dr. Yamamoto adds that statins should be thought of as “vascular protective medications” since these meds have the ability to “protect arteries, prevent plaque growth, and—most importantly—prevent heart attacks, strokes, brain damage, and premature death.”
Side effects of statins
And while they’re so common and approved by the Food and Drug Administration (FDA), reactions can occasionally occur from the use of statins. (A December 2018 analysis released by the American Heart Association stated that the side effects of statins are rare—and that the benefits outweigh the risks.) Here are possible side effects of statins:
1. Aches and pains
Both physicians we spoke to agree that aches and muscle pains (also called myalgia) are the number one complaint from patients, with anywhere between 4% and 10% of people being affected. “It’s important to note that 1 in 20 of us are prone to easily develop muscle aches,” Dr. Yamamoto adds.
Certain lifestyle modifications can help lower risk of myopathy and muscle damage, including reducing vigorous exercise (since the intensity of the workouts could put strain on already-inflamed muscles) and taking a coenzyme Q10 dietary supplement.
Dr. Yamamoto says that because CoQ10 is made in the muscles, statin therapy may deplete it from the system, resulting in muscle soreness. “Vegans tend to be more prone to the aches and pains associated with statin use since CoQ10 is naturally found in red meat,” he says. “But keep in mind that being vegan in no way makes us immune from the effects of time, and the leading cause of death for vegans is still cardiovascular disease.”
2. High blood sugar
“Statins can also increase blood sugar levels in people with metabolic syndrome, pre-diabetes or borderline blood sugar levels,” Dr. Haythe explains. A 2017 study published in the journal BMJ Open Diabetes Research & Care observed that statins were associated with “significantly higher rates of diabetes” in patients who were at high risk of developing type 2 diabetes.
3. Elevated liver enzymes
Some patients will occasionally experience liver inflammation from taking statins, according to The Mayo Clinic. Yet the numbers are small—an article published in a 2013 edition of the journal Gastroenterology & Hepatology says that clinical trials show that statins have been linked with elevations in serum alanine aminotransferase (ALT, an enzyme found mostly in the liver and kidney) in an average of 3 percent of patients.
Symptoms of liver damage include extreme fatigue, loss of appetite, pain in the upper body, urine that is dark in color, and/or yellowing of the skin or eyes. If the liver enzyme increase is minimal, patients can continue taking statins, but if liver function becomes severely impacted, a different med will likely be prescribed.
4. Memory loss and confusion
Harvard Medical School points to a 2015 study published in JAMA Internal Medicine that explored a possible connection between cholesterol-lowering medications and memory loss. After reviewing the medical records of approximately 11 million patients, the researchers discovered that adults who took statins (as well as any type of cholesterol drug) were about four times more likely to report cognitive impairment compared to those who weren’t taking the same class of meds. However, Harvard adds that an association is unlikely “given the fundamental differences in how statin and non-statin cholesterol drugs work.”
Furthermore, in a 2016 issue of the journal Diabetes Care, study authors from Israel analyzed the results from similar observational and prospective randomized trials. Their findings: Reported cases of memory loss were rare, and the investigators concluded that a “causal relationship has yet to be established.”
Other reported side effects from statins include:
- Difficulty sleeping
Risk factors for statin intolerance, according to the Mayo Clinic, include:
- Are female
- Are over the age of 80
- Have a small body frame
- Have kidney failure or liver disease
- Have hypothyroidism or a neuromuscular disorder
- Take certain medications to treat cholesterol or infections
- Consume excessive alcohol
- Consume large amounts of grapefruit, including grapefruit juice
Dr. Haythe says that some side effects of statins can be managed with the help of a clinician, who may suggest switching to a different statin or lowering the dosage of the medicine. Speak with your doctor if you’re experiencing any adverse effects.