Statin Drugs Lower Cholesterol

Q:  Can you advise me about the safety of statin drugs for high cholesterol? My "bad" cholesterol is high (203) but my "good" cholesterol is okay (52).

I am a 45-year-old female and I'm 25 pounds overweight and have a lot of stress. I also have a family history of diabetes, stroke and heart disease.

My doctor gave me 20 mg of simvastatin (Zocor), saying that diet and exercise wouldn't make a big enough difference. Now I am experiencing muscle soreness. My doctor did check my muscle enzyme levels and they are okay, but he could not guarantee me that the medicine has not affected my muscles.

Is there anything else I can do besides take this medicine?

A:  Statin medications are some of the most commonly prescribed medications in this country. The reason is twofold: High cholesterol is common and these medications do a very good job of lowering cholesterol. Recent research now suggests that statins cut the risk of heart attacks and strokes by about 30% in almost all individuals.

Of course, a 30% reduction in risk is much more meaningful when your baseline risk is high, such as in a person who already has heart disease, than when your baseline risk is low, such as in a relatively young person who doesn't smoke and doesn't have high blood pressure or diabetes. It seems your only risk factors are the cholesterol level and your family history.

The National Cholesterol Education Program recommends starting statin therapy in anyone with a "bad cholesterol" (LDL-C) greater than 190. With statin therapy, they also encourage "lifestyle modifications" such as weight loss, low-fat diet and exercise.

By the way, your goal LDL cholesterol is even lower than the 190 cut-off designated for initiation of medications: Your goal is 160. Cholesterol goals vary by a person's risk factors.

On the other hand, you are right to be concerned about the side effects of any medication. About 1% to 5% of people taking statins complain of muscle pains, but only a very small percentage has overt myositis (diagnosed with a high muscle enzyme level) or any serious muscle complication. If you are taking other medications, such as gemfibrozil, muscle side effects are more common. Pravastatin may be a better choice than simvastatin.

Still, statins are relatively safe medications, so much so that Great Britain has now allowed a statin medication to be sold over the counter without a prescription.

Very low-fat diets can lower cholesterol as much as 20%, but usually more like 5% to 10% (to about 180 in your case). Low-fat diets in combination with other techniques such as exercise, stress management and support group therapy can also prevent heart disease.

Combination diets of oats, barley, soy protein, almonds and cholesterol-lowering margarine (plant sterols) can lower cholesterol as much as 30% but have not been proven to prevent heart disease. In comparison, statins can lower cholesterol 30% to 60%.

So, I do think a statin medication would be helpful for you, particularly if you can find one that does not cause bothersome muscle soreness. But also trust your instincts to work on weight loss and stress management.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.