Cardiovascular
Statins
HMG-CoA reductase inhibitors — Lower cholesterol and cardiovascular risk — names ending in "-statin".
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Statins are the main drugs used to lower cholesterol and reduce the risk of heart attack and stroke, both in people who have had cardiovascular events (secondary prevention) and in those at raised risk (primary prevention).
How it works
They inhibit HMG-CoA reductase, the rate-limiting enzyme the liver uses to make cholesterol. The liver responds by clearing more LDL ("bad") cholesterol from the blood. Statins also have plaque-stabilising and anti-inflammatory effects that contribute to their benefit.
In practice
In practice most muscle aches are not dangerous and often settle or respond to a switch or dose reduction; true rhabdomyolysis is rare. The bigger problem is people stopping because they "feel fine", so it helps to frame statins as long-term cardiovascular insurance rather than a symptom treatment. Recheck lipids to confirm response, and review interacting medicines before adding one that raises statin levels.
Examples
Practical use
How to take it & use it well
- Take it regularly each day. Some types work best taken at night, while others can be taken at any time, so follow the advice for your specific statin.
- You can take it with or without food, but try to keep to the same time each day to build a habit.
- Avoid grapefruit and grapefruit juice with certain statins, as it can raise the level of the medicine and increase side effects.
- If you miss a dose, skip it and take the next one as normal. Do not take two together to make up for it.
- Report any unexplained muscle pain, tenderness or weakness to your doctor, as it can occasionally signal a more serious muscle problem that should be checked.
- Keep taking it long term even when you feel well, as the benefit comes from continued use over years.
Common uses
- Secondary prevention after cardiovascular disease
- Primary prevention in those at raised 10-year risk
- Familial hypercholesterolaemia
Monitoring
- Lipid profile to assess response
- Liver function before and after starting
- Creatine kinase if significant muscle symptoms occur
Weighing it up
Advantages & disadvantages
Advantages
- They lower cholesterol and strongly reduce the risk of heart attacks and strokes.
- They benefit people who already have heart disease as well as those at high risk of developing it.
- They are usually taken once a day and are well tolerated by most people.
- They are inexpensive, widely available on the NHS and backed by a large body of evidence.
- They have effects beyond cholesterol that help stabilise fatty deposits in the arteries.
Disadvantages
- Some people experience muscle aches, though serious muscle problems are uncommon.
- They can occasionally affect the liver, so a blood test is done before starting and during treatment.
- They may slightly raise blood sugar and the chance of developing diabetes in those already at risk.
- They need to be taken long term to keep the benefit, which some people find off-putting.
- Certain types interact with other medicines and with grapefruit.
Key safety principles
What to watch for
- Muscle aches are common; rarely, serious muscle breakdown (rhabdomyolysis) can occur — report severe or widespread muscle pain.
- Interactions (e.g. some antibiotics, antifungals and grapefruit juice with certain statins) raise levels and muscle risk.
- Avoid in active liver disease and in pregnancy.
Key interactions
What to avoid or check alongside
- Grapefruit and grapefruit juice can raise the level of some statins and increase the risk of muscle side effects.
- Some antibiotics and antifungal medicines can raise statin levels and the risk of muscle problems.
- Certain heart medicines, including some used for rhythm problems, can interact and need dose adjustment.
- Combining with other cholesterol-lowering medicines such as fibrates can increase muscle side effects.
- Some HIV medicines and immune-suppressing drugs interact and require careful selection of statin.
- Heavy alcohol use can add to the risk of liver effects.
Patient & carer advice
- Taking it long-term is what delivers the benefit — do not stop because you feel well
- Report unexplained muscle pain, tenderness or weakness
- Some statins are best taken in the evening — follow the specific advice for yours
Use with
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Answers
Statins: frequently asked questions
Will statins cause muscle pain?
Many people take statins without any muscle problems. Some get mild aches. If you develop unexplained or severe muscle pain or weakness, contact your doctor, as it should be checked.
Do I have to take it at night?
It depends on the statin. Some work best at night because the body makes most cholesterol then, while others work equally well at any time of day. Follow your label.
Can I stop once my cholesterol is normal?
Usually not. The cholesterol falls because the statin is working, and it will rise again if you stop. The protection comes from continued long-term use.
Can I drink alcohol with statins?
Moderate drinking is usually fine, but heavy alcohol use can strain the liver, which statins also act on, so keep within recommended limits.
Is it safe in pregnancy?
Statins are generally stopped during pregnancy and when trying to conceive. Speak to your doctor if you are planning a family.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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