Statin Medications - How they Work, Who Can Benefit and Common Misconceptions
Statins represent a class of widely prescribed medications within preventative medicine, with extensive research supporting their safety and efficacy since their introduction in the 1970s. Notable examples include brand names such as Crestor (Rosuvastatin), Lipitor (Atorvastatin), and Pravachol (Pravastatin).
Statins are generally prescribed in two primary scenarios:
Secondary Prevention: Following a diagnosis of heart disease, myocardial infarction (heart attack), or stroke, to mitigate the risk of future cardiovascular events.
Primary Prevention: To reduce risk in patients with diabetes or those exhibiting elevated cholesterol levels, particularly high low-density lipoprotein (LDL) cholesterol, which correlates directly with arterial plaque buildup. A normal LDL level is considered to be below 100 mg/dL. For patients with LDL levels exceeding this threshold, the American Heart Association’s PREVENT Online Calculator is utilized to assess the 10-year risk of heart attack or stroke. If this calculated risk surpasses 7.5%, statin therapy is often recommended.
Statins function by inhibiting the HMG-CoA reductase enzyme in the liver, thereby reducing hepatic cholesterol synthesis and increasing the clearance of LDL cholesterol from the bloodstream. Additionally, statins possess anti-inflammatory properties within blood vessels and contribute to the stabilization of existing atherosclerotic plaques, preventing their rupture and subsequent arterial occlusion.
While generally well-tolerated, statin medications carry certain risks. Approximately 6% (1 in 15) of patients may experience myalgia (muscle aches), which typically resolves upon discontinuation of the medication and often does not recur with a switch to a different statin within the class. A minor potential increase in the risk of developing diabetes has also been observed; however, the cardiovascular benefits of statin therapy generally outweigh this risk.
The increased use of statins and public scrutiny regarding pharmaceuticals have led to various online misconceptions regarding their safety. These are largely based on studies that have been refuted by more robust research. Two prevalent misconceptions include:
Dementia/Memory Loss: There is no substantial evidence to suggest that statins cause dementia; conversely, some studies indicate a potential protective effect against dementia through stroke reduction and improved cerebral blood flow.
Impact on Muscle Building/Workouts: While online articles may cite increased muscle enzyme levels with statin use, there is no evidence to support that these elevated levels result in muscle damage, decreased strength, or inhibition of muscle repair.
Statin medications have been extensively studied and utilized for nearly five decades, demonstrating substantial benefits with a low incidence of side effects. Misinformation regarding their safety, particularly on social media and the internet, has contributed to decreased adoption. Patients are encouraged to engage in a comprehensive discussion with their physician regarding the individual benefits and risks, allowing for accurate interpretation and evaluation of claims. Below are links to the Prevent Calculator and relevant scientific studies for further reference.
The effects of statins on exercise and physical activity: https://pubmed.ncbi.nlm.nih.gov/28807461/
Interpretation of the evidence for the efficacy and safety of statin therapy: https://pubmed.ncbi.nlm.nih.gov/27616593/
Statin Initiation and Dementia Incidence in a Large Health Care System From 1997 to 2020: A Target Trial Emulation Study: https://pubmed.ncbi.nlm.nih.gov/40577672/
Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association: https://www.ahajournals.org/doi/full/10.1161/ATV.0000000000000164?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
Prevent Calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-risk-calculator/prevent-calculator
