All the Benefits and Risks of Statins

Statins reduce the concentration of cholesterol in the blood and prevent cardiovascular disease. Although they're considered safe, they can have certain side effects.

Written and verified by the doctor Mariel Mendoza.

Last update: 03 November, 2022

Statins are useful in lowering cholesterol and in the prevention of cardiovascular disease. This is, above all, acute myocardial infarction and cerebrovascular disease.

They are indicated in patients with blood low-density lipoprotein (LDL) cholesterol greater than or equal to 115 mg/dL or total cholesterol greater than or equal to 200 mg/dL, with high cardiovascular disease risk, or as treatment of established cardiovascular disease. Although they’re considered effective and safe, they have been associated with adverse reactions in a limited number of cases.

How do statins work?

Statins inhibit the critical step in hepatic cholesterol synthesis: conversion to mevalonate. Cholesterol is a lipid produced in the liver that has multiple functions in the body, such as a precursor of hormones and a component of cell membranes.

By blocking its synthesis, circulating cholesterol in the blood must be used, which reduces the blood concentration. In addition, the mevalonate pathway influences endothelial function, inflammatory response, and coagulation. Thus, the effects of statins are considered to go beyond lowering blood cholesterol.

Statins include the following:

• Atorvastatin
• Fluvastatin
• Lovastatin
• Pitavastatin
• Pravastatin
• Rosuvastatin
• Simvastatin

High cholesterol levels are associated with the formation of atheroma plaques (atherosclerosis) in blood vessels. This condition blocks blood flow, decreasing oxygen delivery to tissues.

The benefits of statins

As we made clear, science has found that statins have effects beyond circulating cholesterol. Therefore, they are considered much more than lipid-lowering drugs.

The help reduce cholesterol

The minimum effective doses of the different statins achieve a 20-50% reduction in LDL cholesterol concentration. They’re used after a stroke or myocardial infarction to reduce the risk of another episode. Also, statins are used when there are high blood cholesterol levels associated with an increased risk of cerebrovascular disease (as primary prevention).

They have pleiotropic effects

The process of atherosclerosis involves not only high cholesterol concentrations, but also endothelial dysfunction, persistent inflammation, and clot formation. Statins inhibit the formation of mevalonate products that modulate the different mechanisms of atherosclerosis.

They can improve endothelial function

Endothelial dysfunction is one of the main factors associated with atherosclerosis and is exacerbated by multiple situations, such as the following:

• Diabetes
• Obesity
• Smoking
• High cholesterol
• High blood pressure

Statins promote blood vessel dilation, secondary to increased nitric oxide. Thus, they become a protective factor.

They have anti-inflammatory effects

Statins decrease the production of proinflammatory factors, such as C-reactive protein and certain forms of interleukins. The effect decreases the adhesion of molecules associated with cardiovascular disease.

Statins have a cardioprotective function

Statins stabilize existing atheroma plaques, preventing them from increasing in volume by incorporating more cholesterol. Oxidation of the substance is reduced, and the risk of a plaque accident is reduced.

They have an antithrombotic effect

In the case of atherosclerosis, after there’s endothelial dysfunction and inflammation, thrombi form and impede blood flow. Statins affect thrombus production by reducing platelet aggregation factor expression, decreasing thrombin synthesis, and the expression of its receptor on the platelet surface.

In addition, the activity of different procoagulant factors (fibrinogen and factors V, VII, and XIII) is reduced with treatment.

The risks of statins

Despite being considered safe, up to 0.5-1% of patients present adverse effects. The most frequent is muscle damage and neurological disorders.

Liver disease

Generally, statins only show an increase in the level of liver enzymes (transaminases), which indicates liver inflammation. Associated symptoms such as fatigue or weakness, loss of appetite, pain in the upper abdomen, dark-colored urine, and yellowish skin or eyes may also occur.

These cases are associated with people with previous liver disease that sometimes goes unnoticed at the time of drug indication. For this reason, it’s recommended that a transaminase control be performed before and during your treatment with statins.

Muscle damage

Muscle damage from statins is manifested by pain, weakness, and spasms. This can be mild discomfort or severe enough to make daily activities difficult.

Rarely, muscle damage can be severe and cause rhabdomyolysis. This situation manifests in severe muscle pain, liver damage, and even kidney failure. The condition has been linked to pre-existing risk factors or a combination with certain medications.

Diabetes

Statins are associated with increased blood glucose levels (blood glucose), which can lead to the development of type 2 diabetes mellitus. The risk is small, but the U.S. Food and Drug Administration (FDA) has issued a warning on labels.

This adverse effect is associated with people who previously had higher than normal blood glucose levels. That is why the use of the drug requires frequent monitoring.

Neurological conditions

From a neurological standpoint, statins can cause memory loss, confusion, or insomnia. These are symptoms that reverse once the drug is stopped.

The pros and cons of statins should be considered

In case of high blood cholesterol levels, a balance should be made between the benefits and risks of statins. Sometimes, changes in diet and lifestyle habits are effective in lowering lipid levels.

Statins lower blood cholesterol concentrations, reducing the risk of high blood pressure, cerebrovascular disease, myocardial infarction, and other conditions. On the other hand, their adverse effects are uncommon (less than 1%), and most people tolerate them well.

It’s recommended that, in the presence of any adverse effect, the dose should not be reduced without first consulting a physician. The presence of undesirable reactions to statins is associated with previous risk factors, such as low muscle mass, hypothyroidism, vitamin D deficiency, alcohol consumption, azole antifungals, or tricyclic antidepressants. Eliminating or reducing risk factors may help to reduce adverse effects.