12 Reader Questions About Cholesterol Reducers (Statins)

Two million Dutch people take a statin every day, such as simvastatin, rosuvastatin and pravastatin. These agents inhibit the production of cholesterol in the liver and lower the cholesterol level in the blood by 25 to 45 percent. Statins also reduce arteriosclerosis. As a result, they reduce the risk of a heart attack and stroke.

I have been taking a statin for high cholesterol for fifteen years. Yet I had a heart attack and my arteries turned out to be clogged again. How is that possible?

Sonja Keizers: “Statins reduce the risk of a heart attack, but offer no guarantees. Moreover, not only high cholesterol is a risk factor for cardiovascular disease. High blood pressure, smoking and diabetes also increase the risk of a heart attack. It could also be that your cholesterol was not lowered enough, despite the statin.”

Because I have type 2 diabetes, I have been taking pravastatin for five years as a precaution. How long should I continue with this? My cholesterol level is good.

“Your cholesterol is probably good thanks to the statin. As a type 2 diabetes patient, you belong to the risk group for vascular problems. That is why it is wise to continue taking a statin. You can further reduce your risk of vascular problems by exercising, eating healthy and losing weight. Quitting smoking also lowers your risk.”

My thyroid is not working properly. That is stable with a lot of effort, but now my doctor has made me take a statin. Will this affect my thyroid hormone?

“No, that shouldn’t be a problem. Statins do affect the effect of some other medicines, such as certain antibiotics. And if you’re taking simvastatin, you shouldn’t drink grapefruit juice.”

I am a runner, I take simvastatin and because of this drug I suffer from a lot of muscle pain. Are there statins that don’t give you muscle pain?

“In principle, all statins can cause muscle and joint complaints. One gets it and the other doesn’t. So it’s definitely worth trying another statin. About 10 percent of the people who take a cholesterol-lowering agent suffer from muscle pain as a side effect. Usually this is harmless. Very occasionally, in less than 1 percent, it is not harmless and the statin causes muscle breakdown with elevated liver values. This can be determined with blood tests. If it is not clear whether a complaint is caused by a statin, you can temporarily stop the drug in consultation with your doctor. If the complaint disappears and comes back when you start taking the statin again, you know that the statin is the cause.”

I often suffer from leg cramps at night. Is this because of simvastatin?

“It could indeed be because of the statin. But leg cramps can also have other causes, such as lack of fluids. At an older age, many people drink too little without noticing because their thirst stimulus decreases. Leg cramps can also be caused by a magnesium deficiency. A nutritional supplement can then help. Kidney problems can also be a cause. If other possible explanations fail, switching statins may be helpful.”

Can you replace statins with red yeast rice capsules?

“Yes, but be careful with that. Red yeast rice supplements contain the natural statin lovastatin. Some people think this is good because it comes from nature. But you just take a statin with the same possible side effects. Do you take capsules with red yeast rice, always tell your doctor or pharmacist. it’s not a registered drug.”

Statins give me headaches. I’ve tried red yeast rice capsules, but they also give me a headache. What now?

“Headache can indeed be a side effect of statins, but also of red yeast rice capsules. You could try another type of cholesterol inhibitor, such as ezetimibe. This is used in addition to or instead of a statin. It works in a different way and is slightly less effective. Talk to your doctor about it.”

My cholesterol remains too high, even though I take a statin. I heard that there are also injections against high cholesterol. Does that help better?

“Injections can be an alternative for patients with high cholesterol and a high risk of cardiovascular disease. These are injections with alirocumab or evulocumab. Both drugs inhibit the enzyme pcsk9. The injections are effective, but they are only reimbursed for patients with high cholesterol and a high risk, i.e. if they have already had a heart attack, if there is a family history of high cholesterol, or if they have diabetes and have had a stroke or heart attack. injections are only reimbursed if statins in combination with ezetimibe have insufficient effect, or if these drugs are not tolerated.”

After taking statins for 18 years, I started experiencing muscle pain. My doctor allowed me to stop taking the statins because I am already 79 years old. Has he given up on me now?

“No. Your doctor has probably estimated that your risk of cardiovascular disease is not great. It can then – if you suffer from side effects – not hurt to stop. This is especially true if you have never smoked, low blood pressure are not overweight and only take the statin to lower your cholesterol. Statins statistically reduce the risk of a heart attack by a few percent in the next ten years. Your risk has already been reduced because you have been taking statins for 18 years.”

I have been taking rosuvastatin for years and I suffer from constipation. Bowel examination yielded nothing. Is this because of the statin?

“It could. About 10 percent of statin users suffer from intestinal problems, so it may be worth trying a different statin.”

After taking statins for 25 years I have liver problems. Are statins harmful to your liver?

“Which can. If you have elevated liver values, this may indicate muscle breakdown. Statins can also have a direct effect on the liver. This can cause hepatitis or jaundice. But this occurs in only 0.01 to 0.1 percent of patients. Those who drink a lot of alcohol are more likely to develop liver problems with statin use. You can read more about liver problems in the package leaflet of the statin. Usually the pharmacist only tells about the most common side effects such as muscle pain, and not about side effects that occur much less often.”

For years I took the statin Crestor. This was converted to rosuvastatin by the pharmacy. Fortunately, I now get Crestor again, but from now on I have to pay for it myself. Why is that?

“In 2017, the patent on the brand-name drug Crestor expired. Many patients have since been given the unbranded drug rosuvastatin, which is four times cheaper. Crestor is only reimbursed when there is a medical necessity. A condition is that the patient first has one or two cheaper drugs. resources and that this has demonstrably led to problems.”

This article previously appeared in Plus Magazine June 2019. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!