Your questions about statins…

16 November 2018

Answered by Maria Yiangou, a pharmacist in our Health at Hand team. If you have a health concern, you can contact the team anytime, 24/7.

Q. Who should take statins?

A. Statins are some of the most commonly prescribed medicines in the UK, with over seven million of us taking them to lower the level of low-density lipoprotein (LDL, aka  ‘bad’ cholesterol) in the blood. 

Cholesterol is a type of fat produced by the liver. We also get a small amount from our diet. We all need and have some cholesterol in our blood, but some people can have too much. High cholesterol is bad because it can clog up your arteries, increasing your risk of a heart attack and stroke.

Doctors will prescribe a statin if they believe you’re at increased risk of cardiovascular disease.

They’ll make this call based on a number of factors, including your age – heart disease risk increases as you get older. Other factors that can raise your heart risk include:

  • If you have already had a heart attack or stroke
  • Smoking
  • Being overweight
  • Having a family history of heart disease or high cholesterol
  • Having high blood pressure
  • Having certain medical conditions, such as diabetes
  • Your ethnicity – South Asians, for example, have an increased risk of developing heart disease, says the World Health Organization (WHO).

Q. What are the benefits of taking a statin?

A. Statins can lower your ‘bad’ LDL cholesterol by up to 50%. They also increase your ‘good’ HDL cholesterol.

Even if you do not have high cholesterol, your doctor may still recommend that you take a statin to reduce your risk of cardiovascular disease. Anyone who has had a heart attack or stroke, or who suffers from a condition called peripheral vascular disease, is likely to be prescribed a statin, regardless of cholesterol levels.

If you have diabetes, your doctor may also advise you to take a statin. 

This is because people with diabetes are between two to four times more likely to develop cardiovascular disease than someone without diabetes, according to Diabetes UK.

Many of the risk factors for type 2 diabetes, such as carrying too much weight around your tummy, also raise your risk of heart disease. What’s more, high levels of blood sugar can also damage your arteries, making you more prone to heart attack and stroke.

Research shows statins can reduce rates of cardiovascular disease in people with diabetes, even amongst those considered to have a ‘low’ cholesterol level.

Q. What about side effects?

A. It’s important to remember that all medicines have side effects, and statins are no exception. 

However, for the majority of people taking statins, the benefits in terms of reduced risk of heart attack or stroke will outweigh the risk of side effects. Your doctor will carefully consider these relative merits and risks. 

Some people who take statins may experience minor side effects such as nausea, difficulties sleeping, cold-like symptoms or nosebleeds, headaches, and facial flushing. Many people experience a change in their digestive system - this may be simple flatulence or more marked change in bowel habit. A few people report skin rashes and there is recent evidence to indicate that mild memory loss can occur infrequently - this reverses when the drug is stopped!

There are many makes of statin and switching to a different one may help.

More rarely, statins can affect the function of your liver. Your doctor will be checking for this. People with liver problems or those who drink excessively should avoid statins.

And statins can occasionally cause muscle problems, which can be serious. You should speak to your doctor if you experience muscle pain, tenderness or weakness that cannot be explained. 

I take Levothyroxine for an underactive thyroid and have recently begun to take statins. The leaflet with the statins says 'take special care with Simvastatin if you have an underactive thyroid.' Can I take Simvastatin if I have an underactive thyroid?

There are two well-recognised connections between thyroid function and statins.

  • Cholesterol 

An underactive thyroid can increase cholesterol levels in the body. Therefore if the thyroid treatment (in your case, Levothyroxine) is successful there may be no need to take a cholesterol-lowering medication like Simvastatin.

  • Muscle damage 

One of the side effects of statins is called myopathy – an inflammation of your muscles, causing muscle pain, which can sometimes be severe. Having an underactive thyroid can increase the risk of statin-induced myopathy. Statins are more likely to cause muscle damage if you suffer with an underactive thyroid, therefore, while you don’t need to avoid statins completely if you’re taking thyroxine, you should report promptly any unexplained muscle pain, tenderness or weakness and should see your GP if the aching is significant or doesn’t settle.

Q. I am a 66 year old male. I started taking simvastatin 40mg a year ago because I have an increased risk of developing heart disease (weight, BP and waist circumference, reduced exercise.) I have now lost over 1 stone in weight and was wondering if doctors will consider either reducing the dosage or stopping statins should a patient show encouraging signs, e.g. weight loss, reduced waist circumference and reduced BP?

A. I am delighted to hear that you have lost weight. Losing weight can both reduce your ‘bad’ LDL cholesterol and increase your ‘good’ HDL cholesterol, making a significant improvement to the total:HDL cholesterol ratio. It should also improve your blood pressure. 

Statins are usually recommended if your 10 year risk of having a heart attack or stroke (called your cardiovascular risk) is over 20%. If your risk was only just above this, your GP may well be happy for you to stop your statins for a couple of months and check your cholesterol levels again after this time. It will then be possible to recalculate your overall 10 year cardiovascular risk to determine if statins are still indicated. 

I hope it goes without saying that while losing weight, as you have managed so admirably, reduces cholesterol, blood pressure and waist circumference, you need to keep it off to maintain the benefits.

Q. I have been taking statins for 3 years and have had stomach aches and cramps practically non-stop. The pain in my groin and leg has increasingly made it very uncomfortable to walk long distances. 

My GP took me off the statins last week to monitor the results for a month and most of the discomfort disappeared within 48 hours - What a relief! Will the statins have caused any lasting effect on my muscle and tissue and would damage show up on a scan? 

A. As you know statins have been used successfully for many years to help reduce cholesterol levels and therefore reduce the risk of heart attacks and stroke. 

Side effects associated with the use of statins include muscle cramps, soreness, muscle weakness, fatigue and in some cases rapid muscle breakdown. These side effects can vary from person to person. 

Although myalgia, muscle pain, is a commonly reported side effect, true muscle toxicity is rarely due to statin use alone. Sometimes the risk of muscle toxicity can be increased when other medicines are used alongside a statin. Your pharmacist would often spot these and point these out to you. However, because these types of side effects can occur some time after starting a statin, the drug interaction can be missed.

When a doctor suspects that a statin is responsible for muscle pain or weakness, they usually ask for the creatinine kinase (CK) levels to be checked via a blood test. CK levels are usually also checked before starting the statin, so the CK levels following muscular problems can be compared to the baseline. If the CK levels are raised by more than 5 times the upper normal limit then the muscular problems are attributed to the statin, so the doctor will stop the statin temporarily and review the pain. 

After a review, if the muscular aches and pains have stopped, your doctor may prescribe the statin again, this process is known as re-challenge. They may also vary your exercise routine. If the pain returns then your doctor will stop the statin and may prescribe a water soluble statin such as Rosuvastatin or Pravastatin, monitoring all the time for any side effects. 

A scan is unlikely to show any muscle effects. The muscle weakness and other related symptoms usually return to normal after stopping the treatment. I was unable to find any data that relates to statins having a lasting effect on the muscle. 

The decision whether or not to stay on statins is one that you will need to make with your GP. It will be based on factors such as your overall health, other medical conditions you may have, any other medications you may be taking and your family history. The other group of medicines that help reduce cholesterol are called fibrates. Your doctor has your full medical history so will be in a position to decide if an agent from this group is appropriate for you. 

Q. Why can’t people on statins eat grapefruit? 

A. It is known that grapefruits contain a group of chemicals, furanocoumarins. 

The furanocoumarins inhibit an enzyme (cytochrome P450 3A4) that breaks down statins which can result in more of the ‘active’ drug in the body than was intended with the prescribed dose, triggering unpleasant and sometimes serious side effects, such as rhabdomyolysis.

Rhabdomyolysis is the breakdown of muscle fibres resulting in the release of myoglobin into your bloodstream. Too much myoglobin in your blood can damage your kidney.

Q. Does taking statins affect sex life? I have been taking statins for the last two years and now have trouble keeping an erection.

A. Erectile dysfunction – not being able to sustain an erection until ejaculation – is a recognised side effect of many medications, including statins. Ironically, in some patients statins may help with erectile function. This is because getting an erection depends on free flow of blood in the arteries supplying the penis, and atherosclerosis (furring up of the arteries) can affect the arteries of the penis just as much as it can the arteries supplying blood to the heart or the brain. 

It is important not to stop taking any prescribed medication without medical advice. However, do not be worried or embarrassed to talk to your doctor about this. They will be happy to look at whether it is most likely that the statin is causing this problem or whether there could be another cause. If they do think the statin could be to blame, they may be able to change you to a different statin, or a different dose of the same statin. If this still does not solve the problem they will consider with you whether an alternative medicine might help lower your cholesterol.

Q. Is there anything else I can do to lower my cholesterol?

A. Yes. Even if you are taking a statin you should still think about the other ways you can help to keep your cholesterol down.

Some simple lifestyle changes that can make a big difference include:

  • Eat a healthy diet, low in saturated fat
  • Exercise regularly
  • Quit smoking
  • Moderate how much alcohol you drink

Saturated fat is the kind of fat found in butter and lard, pies, cakes and biscuits, fatty cuts of meat, sausages and bacon, and cheese and cream. Try switching to healthier options, such as low fat spreads and olive oil. Nutrition labels on packets will tell you how much saturated fat is in your food. Those that are high in saturated fat contain more than 5g saturates per 100g and are often colour-coded red.

Further reading 

Statins – NHS factsheet

High Cholesterol – NHS Factsheet

NICE guidelines could put 12 million UK adults on statins – British Medical Journal