Statins Have Benefits Beyond Protecting Our Arteries
Harvard Health Letters
Statins can help prevent blood clots
Among other benefits, statins can help prevent blood clots
Harvard Health Letters
For a young physician just entering practice today, life before the statins must seem like the dark ages of cardiology. Since the first statin was approved in 1987, these important medications have improved the outlook for millions of Americans with heart disease or cardiac risk factors.
All in all, statins can reduce the risk of heart attacks and other major clinical manifestations of coronary artery disease (CAD) by up to 37 percent. And since heart disease is America's leading cause of death, it's no wonder that the seven statin drugs are the best-selling prescription medications in
All seven statin drugs act in the same way, by inhibiting the activity of 5-hydroxy-3-methylglutaryl coenzyme A reductase, a liver enzyme that's better known by its short name HMG-CoA reductase. By either name, it's the key enzyme responsible for cholesterol production. When the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But these drugs have another benefit: as cholesterol production falls, the liver takes up more cholesterol from the blood, so blood levels fall even further.
The statins produce only small elevations in HDL ("good") cholesterol, and only atorvastatin and rosuvastatin lower triglycerides, another potentially "bad" lipid, to an important degree.
While the statins' effects on blood cholesterol levels get (and deserve) most of the attention, these powerful medications have many other actions that may protect the heart. In round numbers, a 40-milligrams per deciliter drop in LDL cholesterol produces a 20 percent reduction in coronary deaths. But an exciting 2008 report found that statins may also protect cardiovascular cells directly by speeding DNA repair and slowing cell death. If similar effects occur in other cells as well, they might help explain the nonvascular benefits of statins.
The statins also have anti-inflammatory and antioxidant properties that may protect the arterial wall from being damaged by cholesterol. In addition, they improve vascular function, helping arteries widen to carry more blood to the heart muscle and other tissues. And the statin drugs stabilize cholesterol-laden arterial plaques, reducing the chance that they will rupture and trigger heart attacks.
By inhibiting platelets, the tiny blood cells that initiate blood clotting, statins also help to prevent artery-blocking blood clots. Finally, statin therapy appears to reduce blood viscosity, or "thickness," perhaps facilitating flow through partially blocked arteries.
TARGETING HEART DISEASE
Based on large randomized clinical trials and extensive clinical experience, the
Beyond the coronary arteries
Although the statins deserve their reputation as "heart drugs," they have the potential to affect many organs and tissues. That's no surprise, since every part of the body depends on arteries to supply oxygen-rich blood; every cell in the body is surrounded by a cholesterol-rich cell membrane; vitamin D and the steroid hormones (including cortisol and the male and female sex hormones) are built on a backbone of cholesterol; and the statins have so many actions beyond cholesterol itself.
The widespread actions of the statins also account for the negative effects that can impact many different functions. Fortunately, these adverse reactions are uncommon, and they are generally mild and reversible. Examples include intestinal distress, rashes, liver inflammation, muscle inflammation, aching joints, sleep disorders, headaches, and erectile dysfunction.
Only a small percentage of statin users experience significant side effects, but it's worth remembering that an eighth statin, cerivastatin (Baycol), was withdrawn in 2001 because of severe muscle damage.
If the statins can produce such diverse side effects, is it possible that they also have diverse "side benefits" unrelated to cholesterol and the coronary arteries? A large number of medical studies suggest the answer is yes, with statin drugs getting credit for reducing the risk of conditions ranging from cataracts and prostate cancer to gallstones and chronic lung disease. While these possibilities are intriguing, none has been proven. But before we review the research on noncoronary effects of statins, we should remember the limitations of these studies.
Some claims for possible benefits are based on laboratory experiments in which statin drugs are added to tissue cultures. These experiments show that diverse biological actions of statins are plausible, but they don't necessarily translate into clinical reality.
Some claims are based on animal studies. These, too, are interesting, but there is no assurance that people will react like mice.
Most claims are based on observational studies in which scientists compare the health status of patients taking statin drugs with similar individuals who are not on these medications. Observational studies can establish associations, but they can never prove causality; in other words, it's nice to know that people who take statins are less likely to develop vision-robbing age-related macular degeneration than people who don't take statins, but that doesn't necessarily mean that the statins are responsible for the apparent protection.
Observational studies may also be confounded by the "healthy user effect." For example, early studies linked taking vitamin E with a reduced risk of heart disease, but randomized clinical trials (the gold standard of methods for investigating drugs) subsequently proved that the supplements were not at all beneficial. Perhaps, then, the people who took supplements were also more diligent about eating well, exercising regularly, not smoking, drinking alcohol in moderation, and getting medical care.
Scientists do their best to account for these differences, but in observational studies, it's nearly impossible to entirely exclude the healthy user effect. Finally, many of the studies are small, brief, or otherwise preliminary.
Despite these limitations, studies of how statins might affect various diseases are of obvious interest to the many people who take these highly popular medications. And it's even possible that some of the studies actually underestimate possible benefits because they're too small or brief or don't discriminate between statin drugs that may behave differently. For example, while all statins inhibit HMG-CoA reductase in the liver, there are other differences between them that could impact each drug's actions.
The statins are complex drugs with many actions. They're of proven benefit for reducing the risk of heart attacks and cardiovascular deaths, and a large body of research suggests they may also have important benefits beyond the coronary arteries. -
1. Lovastatin (generic, Altoprev, Mevacor)
Tablet sizes: 10-60 mg
Typical decrease in LDL cholesterol: 20 percent-45 percent
2. Pravastatin (generic, Pravachol)
Tablet sizes: 10-80 mg
Typical decrease in LDL cholesterol: 30 percent-40 percent
3. Simvastatin (generic, Zocor)
Tablet sizes: 5-80 mg
Typical decrease in LDL cholesterol: 35 percent-50 percent
4. Fluvastatin (Lescol)
Tablet sizes: 20-80 mg
Typical decrease in LDL cholesterol: 20 percent-38 percent
5. Atorvastatin (Lipitor)
Tablet sizes: 10-80 mg
Typical decrease in LDL cholesterol: 35 percent-60 percent
6. Rosuvastatin (Crestor)
Tablet sizes: 5-40 mg
Typical decrease in LDL cholesterol: 45 percent-60 percent
7. Pitavastatin (Livalo)
Tablet sizes: 1-4 mg
Typical decrease in LDL cholesterol: 30 percent-45 percent
STATIN VS. STATIN
Natural: lovastatin, pravastatin, simvastatin
Synthetic: fluvastatin, atorvastatin, rosuvastatin, pitavastatin
Lovastatin absorbed best with food
Pravastatin absorbed best on an empty stomach
Fat-soluble, enters the brain: lovastatin, simvastatin, atorvastatin, pitavastatin
Water-soluble, doesn't enter the brain: pravastatin, fluvastatin, rosuvastatin
Rapid; should be taken in the evening: lovastatin, pravastatin, simvastatin, fluvastatin
Slow; may be taken morning or night: atorvastatin, rosuvastatin, pitavastatin
5. Excretion by kidneys
High: pravastatin (reduce dose in kidney disease).
Moderate: lovastatin, simvastatin, rosuvastatin, pitavastatin (reduce dose in severe kidney disease).
Low: fluvastatin, atorvastatin (no dose adjustment for kidney function).
6. Effect on trigylcerides
Little change: lovastatin, pravastatin, simvastatin, fluvastatin
Moderate lowering: atorvastatin, rosuvastatin, pitavastatin
7. Interaction with other drugs
Moderate: the other statins
8. Interactions with grapefruit juice
Levels boosted: pravastatin, rosuvastatin
Levels unchanged: lovastatin, simvastatin, fluvastatin, atorvastatin, pitavastatin
9. Metabolism in people of Asian descent
Higher blood levels: rosuvastatin
Normal blood levels: the other statins
Available at Amazon.com:
- New Book Promises to Reverse Heart Disease with Diet
- Mind-Controlled Prosthetic Arm to Help Amputees
- Is Chocolate Really Healthy?
- Statins Have Benefits Beyond Protecting Our Arteries
- You May Not Be as Thin as You think You Are
- Minimally Invasive Treatments Available For Bothersome Leg Veins
- The Rise of the Superbugs
- Healthy and Whole Convenience Food: Best of Both Worlds Is Possible
- The Case for Caffeine
- Let's Put the 'Public' in Public Defibrillators
- 4 Things Women Should Be Doing in Their Training
- Why You Need More Self-compassion
- Should You Go to a Holistic Dentist?
- Summer Skin: Prep and Protect
- Why 30 Years of AIDS Is Only the Tip of the Iceberg
- Food Allergies and Food Intolerance
- Fill Your Daily Whole Grains 'Gap'
- B Vitamins Play Vital Role in Brain Functioning
- Agave Nectar Is In Demand, But Is It Better Than Sugar?
- Break Your Sugar Addiction
- Gloomy Forecast on Heart Disease
- Biting Your Nails is Bad for Your Teeth
- Breaking Free From Nicotine Dependence
- Maqui Berries Make Splash in Exotic 'Superfruit' Circuit
- Are Electric Toothbrushes Worth the Cost?
- Is Your Work Posture Harming Your Health?
- Experts Revisiting the Use of Antibiotics in Animal Agriculture
- Red Meat: Avoid the Processed Stuff
- What's Behind the Real-sugar Soda Movement?
- Is a juice fast a good way to lose weight?
- The Best Breakfast for Weight Loss
- Prescriptions: Don't Take A Drug Unless You Know Why
- When Pop Stars Become Pop Psychologists
- Harping on Healthy Eating Seldom Gets the Message Across
- Can Worrying Be Good for You?
- Aspirin Therapy: Safe for Sensitive Stomachs?
- Keeping Up With Vaccinations: New Guidelines Include Several Changes
- The Health Benefits of Smiling
- 4 Simple Steps to a Healthy Smile
- Do Home Tooth Remedies Really Work?
- How to Avoid Allergies This Season
- The Surprising Health Benefits of Sex
- Nutrition Is 'In the Pink' with Rhubarb
- Four Sob Stories: The Effect of Tears and Three Other Tales of Woe
- If You Choose to Take Vitamins As Supplements Stick to the RDA
- Spring-clean Your Life Guide: Detox Your Home
- The Truth About Booze: Distinguishing Fact From Fiction
- Use Bold and Beautiful Spices for Health
- Much (Well Deserved) Ado About Mangoes
- Could Fluoride Rinses Help Prevent Cavities
- Can Clutter Make You Sick?
- Medical Schools Embrace Alternative Medicine
- Pre-Existing Conditions? Health Insurance Options Improving
- Washington D.C. Tops On Well-Being Index
- Spring-clean Your Life Guide: Clean up Your Diet
- Why Eating While Distracted Can Make You Fat
- Lose Fat With Your Dentist's Help
- Heart-Healthy Foods and Supplements Show Promise To Keep Cholesterol In Check
- Urban Legends on Wine Headaches and Sensitivities Abound
- Is Coffee Bad For You? Check the Evidence Before You Decide
- Organ Donation Demystified
- Is It Alzheimer's?
- Spring-clean Your Teeth
- Can That Dental Procedure Wait?
- Yes, Doc: I Have a Dirty Mouth!
- The Only 10 iPhone Health Apps You Need
- Drinking Water Before Meals to Lose Weight
- Sleep Is Not Enough: Getting the Rest You Need
- The Great Fat Debate Continues
- Refined Carbohydrates May Be Even Worse For You Than Saturated Fat
- Guess What You Just Ate: Watch Labels For Food Additives
- How to Talk to Your Doctor
- Spring-clean to Stay Healthy
- Mindful Eating: Savoring Your Food Has Physical and Psychological Benefits
- Cholesterol That's Good for Your Brain
- Tips For Natural Allergy Relief
- Insulin Toppled As Ruler of Diabetes
- Sneaky Diet-spoilers
- Foods That Help Men Stay Healthy
- Broccoli Rabe: Broccoli's Bolder Cousin
- Aromatherapy: Simple Tips for a Healthier You
- Is Chewing Gum Good or Bad for My Teeth?
- 5 Habits to Help You Get Enough Sleep
- Understanding Headache Pain: Causes and Treatments Vary Widely
- Take the 'Small Steps' Challenge to Discover a Healthier You
- Hand-washing 101: Kill Germs, Don't Spread Them
- Pilot Safety Secrets for Dentists
- Healthy Diet Can Help Ward Off Type 2 Diabetes
- Overcoming Insomnia: Lifestyle Changes, Medication, Psychotherapy Can Help
- Everybody Say Om: The Real Powers of Meditation
- Green Veggies and Fruit Pack a Big Nutritional Punch
- Many Mouthwash Claims Don't Hold Up
- Know Your Vitamins: Vitamin K
- Health Benefits of Tea
- Spring-cleaning Checklist for Your Health
- Fasting Can Have Many Benefits for the Body
- The Glycemic Index Explained
- Letting Go of Grudges Helps Your Health
- Health and Wellness With Doctor Oz
- Foods to Boost Your Moods
- How Terrible is it to Skip Meals?
- Is Your Lunch Safe to Eat?
- Create a Healthy Diet
- 8 Foods for a Beautiful Smile
- Image Makeover Turning Coffee Into a Health Food
- Pick Blueberries for Brain Defense
- Tips to Manage Blood Sugar
- 5 Fats You Should Eat Every Day
- Does Money Buy Happiness?
- Vitamin Sources From A to K
- The Important Vitamin You May Be Forgetting
- Fill 'Er Up! Protein At Breakfast Impacts Satiety
- Preexisting Conditions Common in United States
- Talking to Teens About Marijuana: 9 Do's and Don'ts
- Break Habits That Harm the Heart
- The Pros of Probiotics: What's Good for the Belly Benefits the Brain
- Get Relief For Everyday Aches and Pains
- Seek Immediate Treatment at First Signs of Stroke
- Healthy Lifestyle Choices the Best Way to Minimize Cancer Risk
- Are Drugstore Blood-Pressure Machines Accurate?
- Get Over Your Childhood Eating Habits
- 5 Tricks That Make Your Dentist Happy
- Could You Have Bad Breath Today?
- Eat Less, Live Longer? Calorie Restriction May Boost Longevity
- How Much Protein Should I Eat?
- Are Eggs Good or Bad for You?
- Good Nutrition Vital to Maintain Healthy Immune System
- Guide to Weight Loss Success
- Eating-right Resolutions for Busy People
- Dieting Do's and Don'ts
- Secrets From the World's Healthiest Countries
- Your Cold-fighting Grocery List
- Why Stress Can Be Good for You
- Living-Donor Transplants Are Becoming More Common
- 7 Ways to Beat the Winter Blues Today
- The Dangers of Type D Personality
- Become an Imperfectionist
- 5 Daily Habits for a Healthier You
- Are Germ-killing Products Harming Your Health?
- Get a Step Ahead of Flu Season
- Healthy Lifestyle Changes You Can Make Right Now
Copyright © 2011, Psychology Today Magazine