Statins • Side effects of cholesterol-lowering drugs

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Statins are used to lower cholesterol levels. The active ingredient is therefore important for the prevention of cardiovascular diseases such as heart attacks or strokes – however, side effects are possible.

Too high blood lipid levels are considered a risk factor for cardiovascular diseases such as arteriosclerosis, heart attacks and strokes. In addition to the total value of cholesterol, it is important how high the proportion of harmful LDL cholesterol is. If the levels of LDL are high, statins are prescribed according to the risk factors of the person concerned – and if measures to lower the level of cholesterol in the blood such as exercise and weight loss are not effective.

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What are statins?

Statins are prescription drugs used to treat dyslipidemia (dyslipidemia). They reduce the formation of cholesterol in the liver by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase in liver cells – this plays a central role in cholesterol synthesis.

By inhibiting the enzyme, there is a lack of cholesterol in the cells, which means that they take more LDL cholesterol from the blood plasma. Statins cause the liver to break down more cholesterol. According to studies, they can reduce the level of LDL in the blood by up to 40 percent.

Known drug classes of statins:

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

Statins are taken orally, preferably in the evening. Cholesterol synthesis in the body is strongest during the night. The best LDL-lowering results are obtained with a low dose of the medication.

Statins useful for angina pectoris, after heart attack and stroke

The active ingredients are primarily prescribed to people for secondary prevention. Therefore, patients receiving statin therapy who suffer from cardiovascular disease or who have already had a heart attack or stroke. Those at risk who need treatment also include those with primary diet-resistant hypercholesterolaemia (dyslipidaemia with cholesterol levels that are too high), mixed hyperlipidaemia or familial hypercholesterolaemia. The use of drugs in primary prevention is controversial, ie when there is no disease and only the cholesterol level is elevated.

side effects of statins

Statins are often well tolerated by patients. However, like other drugs, cholesterol-lowering drugs can also cause side effects. Possible are:

In rare cases, muscle disorders (myopathy) may develop – a severe form is the breakdown of striated muscles (rhabdomyolysis). Since the concentration of creatine kinase (CK) increases here, the enzyme is a suitable laboratory parameter if corresponding symptoms of this side effect occur.

Taking statins can result in a reversible increase in transaminase enzyme, which in rare cases leads to severe hepatitis. There is also a risk of clouding of the lens of the eye (cataracts) with long-term statin therapy.

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Possible interactions with other active ingredients

As many statins are substrates of the cytochrome P450 (CYP) system in the liver, there is a risk of interactions with other active substances that are also metabolised there. This applies in particular to CYP inducers, which promote enzyme activity, or CYP inhibitors, which inhibit it. Grapefruit juice also affects CYP as well as other enzyme systems – so many statins should not be taken with the juice.

The combination of statins with fibrates may increase the risk of rhabdomyolysis. Taking phenprocoumon at the same time also has an unfavorable effect. There is no proven direct interaction between alcohol and statins. However, because alcohol affects lipid metabolism, people being treated for a disorder are better off avoiding it.

Contraindications: When not to prescribe statins

Certain health conditions do not allow doctors to prescribe statins. These include liver or muscle disease and known hypersensitivity to the drug. Women should also not be treated with statins during pregnancy and breastfeeding.

Alternatives to taking statins

Statins are drugs of first choice for the treatment of disorders of lipid metabolism. If they cannot be used, there are second line active ingredients that also inhibit the absorption of cholesterol in the body. These include, for example

  • Ezetimibe (can also be taken together with statins)
  • basic non-resorbable anion exchange resins
  • Phytosterol
  • Fibrates (lower LDL concentration and affect HDL metabolism)
Blood count: important values ​​and what they mean


What are statins? Prescription drugs are used for dyslipidemia (dyslipidemia). They inhibit the synthesis of cholesterol in liver cells.

Areas of application: Secondary prevention for people with cardiovascular disease or patients who have already had a heart attack or stroke.

Side effects: Digestive problems, headaches, fatigue and muscle problems such as muscle pain are possible.

Source: Lifeline | Das Gesundheitsportal from

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