June 27, 2023. Children younger than 7 years of ageUse and dose must be determined by your doctor. Copyright 2019 by the American Academy of Family Physicians. The USPSTF found inadequate evidence on the harms of statin use for the prevention of CVD events in adults 76 years and older without a history of heart attack or stroke. Keep from freezing. These can include: muscle aches Statins and Diabetes: What You Should Know | CDC This is consistent with trial evidence, and evidence is insufficient to show improved cardiovascular and all-cause mortality with higher-intensity treatment over moderate-dose statins.11 Moderate-dose statins have fewer adverse effects than high-dose statins; therefore, we strongly recommend them as the first step in therapy to reduce cardiovascular risk.1,6 The ACC/AHA recommends intensive therapy in secondary prevention unless medications cannot be tolerated.2, We recommend offering more intensive therapy to patients who wish to further reduce their risk.1 Switching to high-dose statins and adding ezetimibe or PCSK9 inhibitors to statins reduces nonfatal cardiovascular events more than moderate-dose statins alone, each to a similar extent.11 All were studied primarily in higher-risk populations, such as those with acute coronary syndrome, recurrent cardiac events, or tobacco use. participants who received a daily dose of bempedoic acid experienced a 23.2% reduction in LDL cholesterol and a 22.7% decrease in inflammation caused by a protein in the blood associated with heart and stroke risk. Statin alternative bempedoic acid cuts cholesterol, heart attack risk Follow your doctor's orders or the directions on the label. In most cases, this increase is not associated with serious or permanent liver damage, but care needs to be taken if statins are prescribed to people with underlying liver dysfunction. Based on other guidelines and expert opinion, reasonable options include annual assessment of blood pressure17 and smoking status18 and measurement of lipid levels every 5 years.1 Shorter intervals may be useful for persons whose risk levels are close to those warranting therapy, and longer intervals are appropriate for persons who are not at increased risk and have repeatedly normal levels. Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Your doctor may adjust your dose as needed. Unauthorized use of these marks is strictly prohibited. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. For example, the guideline recommends periodic lipid monitoring in patients receiving therapy, even though randomized trials generally prescribed fixed statin doses rather than titrating to LDL-C percentage reductions or threshold levels. The USPSTF recommendations are independent of the U.S. government. Patients who place a higher value on the potential benefits than on the potential harms and inconvenience of taking a daily medication may choose to initiate statin use for reduction of CVD risk. include protected health information. We suggested that only for absolute contraindication or adverse effects of statins should we adjust LLT, it is better to maintain the dosage of statins after target level achieved. Add 40 mL of water. For example, 41% of men and 27% of women aged 60 to 69 years without a history of CVD will be found to have a calculated 10-year CVD event risk of 10% or greater.16 Many older adults, particularly those aged 65 to 75 years, may meet the recommended risk threshold for treatment with statins in spite of the absence of dyslipidemia, diabetes, hypertension, or smoking. The physician and patient should discuss risk factors before starting statin therapy. In patients on maximally tolerated statin therapy who have an LDL >70 mg/dl, consider adding ezetimibe. Accessibility Coming off statins: Safety, side effects, and risks - Medical News Today A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Cholestyramine light: The starting dose is 1 pouch (4 grams) or 1 level scoopful (4 grams) taken by mouth, once or twice per day. Effect of rosuvastatin compared with other statins on lipid levels and National Cholesterol Education Program goal attainment for low-density lipoprotein cholesterol in a usual care setting. Statins are known to cause muscle aches in a subset of people, which can usually be minimized by reducing the dose. Disclaimer. Use of a statin would reduce this risk to 8 to 9 percent, a three- to four-percentage point reduction if he were treated with a statin daily for 10 years. Nonmodifiable risk factors for CVD include older age, male sex, and race/ethnicity; however, statin trials have not included persons with only these risk factors. Finally, the ACC/AHA did not update the Pooled Cohort Equations risk assessment tool, despite widespread recognition that it can significantly overestimate 10-year risk of myocardial infarction and stroke. No, Recommendations based on patient-oriented outcomes? What are the side effects? A CAC score of 1 to 99 suggests statin therapy, particularly for patients 55 years and older. Find out how atorvastatin treats heart problems and how to take it. The https:// ensures that you are connecting to the Results: Attach the syringe to a nasogastric tube and deliver the contents into the stomach. What Does It Matter If You Have High Cholesterol? Statins Should Go Only to 'High-Risk' Patients. Mayo Clinic does not endorse companies or products. Niacin is a B vitamin that can improve all lipoprotein levels. The 7.5% ACC/AHA treatment threshold is based on an average of control group event rates in primary prevention trials.2 We recommend statin treatment at a 12% 10-year risk in patients with diabetes and in those with LDL-C levels of 190 mg per dL (4.92 mmol per L) or greater to most closely correspond to the clinical trial populations.1 The ACC/AHA similarly recommends treatment in patients who have diabetes and who have LDL-C levels of 190 mg per dL or greater.2 We recommend shared decision-making for treatment between 6% and 12% risk because few trials included patients in this risk category.1 We recommend against medication treatment in people with a 10-year risk less than 6% because evidence is lacking for this group.1, For secondary prevention, we recommend moderate-dose statins as the mainstay of treatment. JAMA. In a 2019 study, researchers looked at the impact of statins on muscles in both humans and rats over the course of 4 weeks. Portions of this document last updated: June 01, 2023. Change your dose. Statin drugs lower cholesterol levels by inhibiting a liver enzyme, known as HMG Co-A reductase, which is key to cholesterol synthesis. Medically reviewed by Drugs.com. PMC Potential Harms. The follow-up LDL-C level was significant higher while the percentage of patients with LDL-C level less than 100 mg/dL was significant lower in patients with statin's dosage decreased. A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide. For all patients, regardless the adjustment of LLT, the percentage of patients with LDL-C level less than 100 mg/dL was significant lower in follow- up lipid profile comparing with the baseline, but only the follow-up total cholesterol and LDL-C level were significant higher in the patients group with reduced statin's dosage. In June 2020, the third iteration of the VA/DoD guidelines on managing dyslipidemia was published1 (see Figure 1 in the related practice guideline in this issue of American Family Physician). Observational evidence suggests there may be an association between very low cholesterol levels and an increased risk of mortality with advanced age, after adjusting for other risk factors.27,28, Current Practice. The Gene That Explains Statins' Most Puzzling Side Effect - The Atlantic Copyright 2017 by the American Academy of Family Physicians. A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf. Evidence indicates that currently available risk calculators tend to overestimate CVD risk, suggesting that actual benefits may be lower than estimated. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults aged 40 to 75 years. This randomized . Read our, This New Drug Lowers Cholesterol Without the Side Effects of Statins. However, clinicians' ability to accurately identify a patient's true risk is imperfect, because the best currently available risk estimation tool, which uses the Pooled Cohort Equations from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the assessment of cardiovascular risk,1 has been shown to overestimate actual risk in multiple external validation cohorts.24 The reasons for this possible overestimation are still unclear. Editor's Note: Dr. Arnold is a contributing editor for American Family Physician. This has been misconstrued by some as meaning that statins have no benefit and, worse yet, maybe harmful. The incidence of CVD events in a population increases linearly with CVD risk level; there is no threshold at which event rates abruptly escalate. health information, we will treat all of that information as protected health In other words, the more likely it is that persons in a certain population will have a heart attack or ischemic stroke, the greater the potential reduction in the number of CVD events with statin use will be in that population. Given the lack of data on the efficacy of screening for or treatment of dyslipidemia in adults aged 21 to 39 years, the USPSTF encourages clinicians to use their clinical judgment for patients in this age group. The USPSTF found no clear evidence of decreased cognitive function associated with statin use. However, evidence concerning the association between statin use and diabetes mellitus is mixed, with 1 prevention trial suggesting that there may be a small increased risk of developing diabetes with use of high-dose statins. Strandberg TE, Feely J, Sigurdsson EL; DISCOVERY study group. January 6, 2020 / Heart Health What You Should Expect From Statin Therapy From benefits to side effects Cholesterol-lowering statin medications have been at the forefront of managing cardiovascular disease for several decades now. Copyright 2023 American Academy of Family Physicians. Initiate use of low- to moderate-dose statins. For homozygous familial hypercholesterolemia: AdultsAt first, 20 milligrams (mg) once a day. Recent findings: Herein, we narratively summarized the available clinical studies (n = 17) and meta-analyses (n = 2) that compared the morning with the evening dose of statins in terms of safety and efficacy, with . 2014;8(3). To help keep this amount constant, do not miss any doses and take the medicine at the same time each day. Do not double doses. How High Cholesterol Levels Increase Stroke Risk, What to Know About High Cholesterol and COVID-19, 2018 Guideline on the Management of Blood Cholesterol, A clinicians guide to statin drug-drug interactions, A historical perspective on the discovery of statins, Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170 255 patients from 76 randomized trials, Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association, Statin Use for the Primary Prevention of Cardiovascular Disease in Adults, Statin therapy for primary prevention of cardiovascular disease, A reduction in the buildup of plaque on the walls of the arteries, The stabilization of plaques so that they don't break off and cause an arterial obstruction in the heart or brain, Decreased arterial inflammation as measured by the C-reactive protein (CRP) test, Decreased blood clot formation at the site of an obstruction. Doing so may enable you to reduce your statin dosage, or possibly even lower your cholesterol enough to enable you to stop the statin. When Statins Don't Work: Reasons Why and What Else to Try - WebMD Statins reduce levels of total cholesterol and LDL-C and, to a lesser extent, triglycerides, and probably have anti-inflammatory and plaque stabilization effects as well.6. Brand name: Lipitor. . Last updated on May 24, 2023. Use this medicine only as directed by your doctor. The determination is made based on . Discuss with patient and selectively offer use of low- to moderate-dose statins. Do not keep outdated medicine or medicine no longer needed. If you have trouble swallowing, you may open it and mix the contents with 1 teaspoon of soft food (eg, applesauce, or chocolate or vanilla pudding). Arteriosclerosis, Thrombosis, and Vascular Biology. Medical uses Statins are usually used to lower blood cholesterol levels and reduce risk for illnesses related to atherosclerosis, with a varying degree of effect depending on underlying risk factors and history of cardiovascular disease. The Cholesterol Treatment Trialists meta-analysis showed that greater degree of LDL-C reductions achieved were associated with proportional reductions in major cardiovascular events.25 However, these analyses were based not on randomized comparisons but the degree of LDL-C reduction achieved. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The USPSTF found 4 trials of statin use for primary prevention that enrolled patients younger than 40 years. Use of low- or moderate-dose statins was associated with a reduced risk of all-cause mortality (pooled risk ratio [RR], 0.86 [95% CI, 0.80 to 0.93]), cardiovascular mortality (RR, 0.69 [95% CI, 0.54 to 0.88]), ischemic stroke (RR, 0.71 [95% CI, 0.62 to 0.82]), heart attack (RR, 0.64 [95% CI, 0.57 to 0.71]), and a composite cardiovascular outcome (RR, 0.70 [95% CI, 0.63 to 0.78]).6, Among the study populations, the proportion of CVD events prevented (i.e., the relative risk reduction) was similar across age, sex, race/ethnicity, lipid level, and other risk factor categories.6 Among trials that stratified participants according to a baseline global cardiovascular risk score, similar relative risk estimates were observed among those classified at a higher vs. lower CVD event risk.10,23. AHA News: Are You Getting Enough Omega-3 Fatty Acids? No trial data evaluated statin use among persons in this age group without CVD risk factors; thus, the evidence is insufficient to know whether statin use provides them the same or less benefit than in similarly aged adults with CVD risk factors. Your doctor may adjust your dose as needed. Simvastatin: Side Effects, Dosage, Usage, and More - Healthline How statins work. If you miss a dose of this medicine, take it as soon as possible. This medicine comes with a patient information leaflet. In addition to this medicine, your doctor may change your diet to one that is low in fat, sugar, and cholesterol. Pleiotropic effects of statins: evidence against benefits beyond LDL-cholesterol lowering. Both moderate- and high-intensity statin therapy reduce ASCVD risk, but a greater reduction in LDL-C is associated with a greater reduction in ASCVD outcomes. The USPSTF concludes with moderate certainty that initiating use of low- to moderate-dose statins for the prevention of CVD events and mortality in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 7.5% to 10% has a small net benefit. Clipboard, Search History, and several other advanced features are temporarily unavailable. The most common include: Statins can also cause an elevation in liver enzymes in one of every 100 users. Given the imprecision in risk estimates, eliciting patients values and preferences regarding the potential benefits and harms of statins and other lipid-lowering agents remains essential to treatment decisions.Kenny Lin, MD, MPH, AFP Deputy Editor, Guideline source: American College of Cardiology/American Heart Association, Systematic literature search described? This is one of the fundamental reasons for the distinction between a grade B and C recommendation for the population that presents with dyslipidemia, diabetes, hypertension, or smoking and a 10% or greater vs. 7.5% to 10% 10-year CVD event risk. All Rights Reserved. The impact of lipid profile changed after LLT adjustment on clinical outcomes needs further studied. 2004 Nov;26(11):1821-33. doi: 10.1016/j.clinthera.2004.11.015. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Throw away any unused mixture. You may take this medicine with or without food. Glueck CJ, Aregawi D, Agloria M, Khalil Q, Winiarska M, Munjal J, Gogineni S, Wang P. Clin Ther. When an initial nonfasting lipid profile reveals a triglyceride level of 400 mg per dL (4.5 mmol per L) or greater, a repeat lipid profile should be obtained to assess fasting triglyceride and baseline LDL-C levels in adults 20 years and older. The following information includes only the average doses of this medicine. Copyright 2023 American Academy of Family Physicians. It's because a large body of research supports their benefits in reducing the risk of heart attack and stroke. Dose timing becomes more important in patients with polypharmacy because it might affect their adherence to the statin therapy. If You Can't Take Statins, This Alternative Can Help Lower Cholesterol Statin drugs are known to significantly reduce the odds of having a heart attack or stroke by lowering the level of "bad" cholesterol in the blood. Verywell Health's content is for informational and educational purposes only. Many patients . Bookshelf Yes, Guideline developed by participants without relevant financial ties to industry? You may opt-out of email communications at any time by clicking on Statins - Low Dose | Spacedoc.com MICHAEL J. ARNOLD, MD, FAAFP, AND PATRICK G. O'MALLEY, MD, MPH, FACP, Uniformed Services University of the Health Sciences, Bethesda, Maryland, JOHN R. DOWNS, MD, FACP, University of Texas Long School of Medicine, San Antonio, Texas, Related practice guideline: Dyslipidemia Management for Cardiovascular Disease Prevention: Guidelines from the VA/DoD, Related letter to the Editor: USPSTF Recommendations for the Management of Dyslipidemia for Cardiovascular Risk Reduction. Ask the doctor: Does it matter when I take a statin? In 2016, the government's U.S. Preventive Services Task Force (USPSTF) issued updated guidelines simply stating that the evidence was " insufficient" to recommend starting statins in people 76 and older who didn't have a history of heart attack or stroke. Do not use more of it, do not use it more often, or do not use it for a longer time than your doctor ordered. Niacin, also known as vitamin B3, plays a role in converting the food a person eats into energy, through using fats and proteins. Limited information is available about use of high-dose statins in a primary prevention population. Take this mixture within 1 hour, without chewing. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. A cornerstone of the guideline is to emphasize a heart-healthy lifestyle for all patients. Managing statin muscle pain - Harvard Health