Ask Your Pharmacist

April 07, 2022
Q:

My doctor told me I have high cholesterol, and we are in discussions about starting a statin. Can you tell me more about this medication?

A:

Cholesterol is a “waxy” substance found in the body that is made by the liver and comes from the types of food we eat. The body needs a certain amount of cholesterol for the normal growth of body cells.

High cholesterol is a risk factor for cardiovascular disease and stroke. When we talk about high cholesterol, we are talking about high levels of a particular type of cholesterol: low density lipoprotein cholesterol (LDL-C) or “bad” cholesterol, circulating in your bloodstream. This bad cholesterol over time causes hardening and narrowing of the blood vessels that supply oxygen rich blood to your heart and your brain. 

Statins reduce LDL-C, and stabilize existing plaques in the arteries. Scientists have determined in addition to lowering LDL-C, statins prevent cardiac events, and stroke. Statins has been linked to a decrease in the rate of dementia.

Statins came to the Canadian market in the 1980’s. They are so named because they all end in “statin” (i.e. (atorvastatin [Lipitor], fluvastatin [Lescol], lovastatin [Mevacor], pravastatin [Pravachol], rosuvastatin [Crestor], and simvastatin [Zocor]). The decision to start statin therapy to lower your cholesterol is one that is made with your physician or nurse practitioner based on your family history, your past medical and current medical history, and blood (i.e., cholesterol panel: LDL-C, high density lipoprotein cholesterol [HDL-C, total cholesterol, and triglycerides]. Your doctor or nurse practitioner will calculate your 10-year risk of having a cardiovascular event based on a medical tool called the Framingham Risk Score (i.e. Framingham Risk Score: https://www.mdcalc.com/framingham-risk-score-hard-coronary-heart-disease ). This score is a validated estimate of your likelihood of a cardiovascular event that takes into account your age, sex, smoking status, total cholesterol measurement, and your systolic blood pressure (i.e., the “top” number of your blood pressure measurement). Cholesterol is measured in the blood in units of mmol/L.  A decrease of 1 mmol/L in LDL results in a 20 percent reduction in cardiovascular events. 

Your pharmacist will review the benefits and risks of statin therapy with you. She/he can help monitor your serum cholesterol levels to see where your LDL is relative to your target levels. 

Most people tolerate statin therapy very well.  The most common complaint is muscle pains, ranging in severity from mild to moderate. Usually, if muscle pain does occur it is minor in nature. Talk to your pharmacist if you experience new muscle pain after starting your cholesterol lowering medication. In some instances, a dose reduction may help relieve this side effect.  Very rarely (i.e., one or two people out of 100,000 people), people taking statins may experience a side effect called rhabdomyolysis. This side effect causes severe pain from muscle damage and is considered a medical urgency. In such rare cases, other forms of cholesterol lowering medication is generally chosen.

The statin family of medications has the potential to cause drugs interactions with certain medications, so be sure to check with your pharmacist before starting any new prescription, over-the-counter, or herbal medications.    

Lowering your cholesterol and enhancing your heart health involves more than just taking a

cholesterol medication. Changes you make to your everyday lifestyle also play an important role. Quit smoking and limit alcohol consumption to no more than moderate amounts. Aim for 150 minutes of moderate to vigorous physical activity per week and include muscle and bone strengthening activity twice a week. Get sufficient sleep (i.e., Untreated sleep apnea is associated with heart disease). Maintain a healthy body weight by exercising regularly and by choosing to eat healthy. Check out Canada’s Food guide on healthy food portions and food choices. 

Eating a Mediterranean diet is closely associated with lower cholesterol, and lower rates of illness from heart disease and stroke. This diet is low in red meat, sugar, and processed food and high in fruits, vegetables, legumes, whole grains, nuts, seeds, and heart healthy fats. Contact a registered dietitian for any specific diet instructions.    

 

Dr. Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.