Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.
LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver.
Why have I been offered statins?
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).
CVD is a general term that describes a disease of the heart or blood vessels. It is the most common cause of death in the UK. The main types of CVD are:
coronary heart disease – when the blood supply to the heart becomes restricted
angina – sharp chest pain, caused by coronary heart disease
heart attacks – when the supply of blood to the heart is suddenly blocked
stroke – when the supply of blood to the brain becomes blocked
Statins are usually offered to people who have been diagnosed with a form of CVD, or whose personal and family medical history suggests they are likely to develop CVD at some point over the next 10 years.
If you are offered statins, you will also be advised about lifestyle changes you can make to help reduce your cholesterol level. These include eating a healthy diet low in saturated fat, exercising regularly,stopping smoking and moderating your alcohol consumption.
Statins come as tablets that are taken once a day. The tablets should normally be taken at the same time each day – most people take them just before going to bed.
In most cases, treatment with statins will need to continue for life, as stopping the medication will cause your cholesterol to return to a high level within a few weeks.
If you ever forget to take your dose, do not take an extra one to make up for it. Just take your next dose as usual the following day.
If you accidentally take too many statin tablets (more than your usual daily dose), contact your doctor or pharmacist for advice.
Cautions and interactions
Statins can sometimes interact with other medicines, increasing the risk of unpleasant side effects, such as muscle damage. Some types of statin can also interact with grapefruit juice.
It is very important to read the information leaflet that comes with your medication, to check if there are any interactions you should be aware of. If in doubt, contact your GP or pharmacist for advice.
Side effects of statins
Many people who take statins experience no or very few side effects. Others experience some troublesome – but usually minor – side effects, such as an upset stomach, headache or feeling sick.
Cases that involve more serious side effects, such as kidney failure, tend to get a great deal of media coverage, but these instances are rare. The British Heart Foundation states than just 1 in every 10,000 people who take statins will experience a potentially dangerous side effect.
The risks of any side effects also have to be balanced against the benefits of preventing serious problems. A review of scientific studies into the effectiveness of statins found that around one in every 50 people who take the medication for five years will avoid a serious event, such as a heart attack or stroke, as a result.
Alternatives to statins
Your doctor may offer statins as a treatment if you are believed to be at risk of CVD. However, it is up to you whether you take them.
Although statins are extremely effective at reducing high cholesterol, they are not the only option. Alternative measures to reduce your cholesterol level include:
eating a healthy diet low in saturated fats
increasing the amount of omega-3 fatty acids in your diet
taking another prescribed medication
Types of statin
There are five types of statin available via prescription in the UK:
When statins may be used
Statins are most often recommended if you have cardiovascular disease (CVD) or have a high risk of developing it in the next 10 years.
CVD is a general term that describes a disease of the heart or blood vessels that is often caused by high cholesterol. It is the most common cause of death in the UK.
The main types of CVD are:
coronary heart disease – when the blood supply to the heart becomes restricted due to the hardening and narrowing of the arteries (atherosclerosis)
angina – sharp chest pain caused by coronary heart disease
heart attacks – when the supply of blood to the heart is suddenly blocked
strokes and transient ischaemic attacks (TIAs) – when the supply of blood to the brain becomes blocked or disrupted
peripheral arterial disease (PAD) – when a build-up of fatty deposits in the arteries restricts blood supply to the limbs
Statins cannot cure these conditions, but they can help prevent them from getting worse or recurring in people who have been diagnosed with them.
They can also reduce the chance of these conditions developing in the first place in people at risk (see below).
Statins are usually used in combination with lifestyle measures such as eating a healthy diet low in saturated fat, exercising regularly,stopping smoking and moderating your alcohol consumption.
People at risk of cardiovascular disease
If you don't have any form of CVD, statins may still be recommended if you are thought to be at a high risk of developing the condition in the future.
The current recommendation is that you should be offered statins if there is at least a one in 10 chance of you developing CVD at some point in the next 10 years.
Your GP may recommend carrying out a formal assessment of your CVD risk if you are over the age of 40 and they think you may be at an increased risk of CVD, based on your personal and family medical history.
For this formal assessment, your GP or practice nurse will use special CVD risk assessment computer software that takes into account factors such as:
your ethnic group, as some have an increased risk of CVD
your weight and height
if you smoke or have previously smoked
if you have a family history of CVD
your blood pressure
your blood cholesterol levels
if you have certain long-term conditions – such as diabetes, chronic kidney disease, rheumatoid arthritis and atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate)
Statins can also be used to treat people with a condition called familial hypercholesterolaemia.
This is an inherited condition caused by a genetic fault, which leads to high cholesterol levels, even in people who have a generally healthy lifestyle.
Cautions and interactions
Statins should not be taken if you have severe liver disease or blood tests suggest your liver may not be working properly.
This is because statins can affect your liver, and this is more likely to cause serious problems if you already have a severely damaged liver.
Before you start taking statins, your doctor should carry out a blood test to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver three months after treatment begins, and undergo another after 12 months.
Pregnancy and breastfeeding
Statins should not be taken by women who are pregnant or breastfeeding, as there is no firm evidence on whether it is safe to do so.
If you do become pregnant while taking statins, contact your GP for advice.
People at an increased risk of side effects
Statins should be taken with caution if you are at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. This can lead to kidney damage (rhabdomyolysis).
Things that can increase this risk include:
being over 70 years old
having a history of liver disease
regularly drinking large quantities of alcohol
having a history of muscle-related side effects when taking a statin or fibrate (another type of medicine for high cholesterol)
having a family history of myopathy or rhabdomyolysis
If one or more of these apply to you, there is a chance that frequent monitoring may be needed to check for complications. A lower dose of statin may also be recommended.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Statins can react unpredictably with certain other substances (known as "interacting"), potentially increasing the risk of serious side effects, such as muscle damage.
Medications that can interact with some types of statin include:
certainantibiotics andantifungals – including erythromycin,clarithromycin, daptomycin, itraconazole, ketoconazole andmiconazole
certain HIV medications – including indinavir, lopinavir, ritonavirand saquinavir mesilate
warfarin – a medication commonly use to prevent blood clots
ciclosporin – a medication that suppresses the immune system, which is used to treat a wide range of conditions includingpsoriasis and rheumatoid arthritis
danazol – a synthetic hormone medication used to treat conditions such as endometriosis
verapamil and diltiazem – types of medication called calcium channel blockers, which are used to treat various conditions affecting the heart and blood vessels
amiodarone – a medication sometimes used to treat irregular heartbeats
fibrates – medications that, like statins, help to reduce cholesterol levels in the blood
If you are taking statins and need to take one of these medications, your doctor may prescribe an alternative statin or prescribe your current statin at a lower dosage. In some cases, they may recommend that you temporarily stop taking your statin.
Food and alcohol
Grapefruit juice can affect some statins and increase your risk of side effects. Your doctor may advise you to avoid it or to only consume it in small quantities.
There are no known interactions between statins and alcohol.
Researching your medication
For full details of cautions and interactions relevant to your specific medication, check the patient information leaflet (PIL) that comes with it.
Online versions of many PILs can also be found in our medicines A-Z.
If in doubt, contact your GP or pharmacist for advice.
Side effects of statins
Like all medications, statins can cause side effects. However, most people tolerate them well and don't experience any problems.
You should discuss the benefits and risks of taking statins with your doctor before you start taking the medication.
If you find certain side effects particularly troublesome, you should talk to the doctor in charge of your care. Your dose may need to be adjusted or you may need a different type of statin.
Some of the main side effects of statins are described below; however, this is not an exhaustive list and some of these will not necessarily apply to the specific statin you are taking. For information on the side effects of a particular statin, check the information leaflet that comes with your medication or search for your medication in our medicines A-Z.
Common side effects
Although side effects can vary between different statins, common side effects (which affect up to 1 in 10 people) include:
a runny or blocked nose (non-allergic rhinitis)
problems with the digestive system, such as constipation,diarrhoea, indigestion or flatulence (passing wind)
muscle and joint pain (see below)
increased blood sugar level (hyperglycaemia)
an increased risk of diabetes
However, it's not clear whether most of the common problems people experience when taking statins are actually caused by the medication itself. A study has suggested that many side effects are similar, no matter if a statin or placebo (dummy medication) is taken. For more information, see the article "Statins side effects are minimal, study argues".
Uncommon side effects
Uncommon side effects of statins (which may affect up to 1 in 100 people) include:
loss of appetite or weight gain
difficulty sleeping (insomnia) or having nightmares
dizziness – if you experience this, do not drive or use tools and machinery
loss of sensation or tingling in the nerve endings of the hands and feet (peripheral neuropathy)
blurred vision –if you experience this, do not drive or use tools and machinery
ringing in the ears
inflammation of the liver (hepatitis), which can cause flu-like symptoms
inflammation of the pancreas (pancreatitis), which can causestomach pain
skin problems, such as acne or an itchy red rash
feeling unusually tired or physically weak
Rare side effects
Rare side effects of statins (which may affect up to 1 in 1,000 people) include:
bleeding or bruising easily
yellowing of the skin and eyes (jaundice)
Statins can occasionally cause muscle inflammation (swelling) and damage. Speak to your doctor if you experience muscle pain, tenderness or weakness that cannot be explained (for example, pain that is not due to physical work).
Your doctor will carry out a blood test to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.
If the level of CK in your blood is more than five times the normal level, your doctor may advise you to stop taking the statin. Regular exercise can sometimes lead to a rise in CK, so tell your doctor if you have been exercising a lot.
Once your CK level has returned to normal, your doctor may suggest you start taking the statin again, but at a lower dose.
Reporting side effects
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you are taking. It is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA).