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This class of drug, which also goes by the tongue-twisting name HMG-CoA reductase inhibitors, has revolutionized the treatment of high cholesterol more than any other medication.In use for more than a decade, statins are sold under the brand names Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin). Additionally, an extended-release form of lovastatin, called Altocor, was approved in 2002. It needs to be taken only once a day; most statins must be taken more often. To prevent confusion, we're going to stick to the brand names.
Statins work by partially blocking an enzyme called HMG-CoA, which controls how quickly your body produces cholesterol. (Remember that your body makes about three or four times more cholesterol than you eat.) By blocking this enzyme, statins put the brakes on cholesterol production. They also increase your body's ability to remove LDL from your bloodstream and bring it to the liver, where it's broken down and eventually excreted. While statins aren't as good as some other drugs at raising HDL levels or lowering triglycerides, they do have some positive effects in those areas.
Statins aren't perfect, however. They don't work very well at transforming small, dense LDL particles (which are more likely to burrow into artery walls) into larger, fluffier particles, or lowering lipoprotein (a) -- Lp(a) -- another particle that may contribute to blood clots and plaque formation. So even if you're taking a statin, your doctor may prescribe additional medications, depending on your other coronary risk factors.
How Well Do Statins Work?
Overall, studies find that statins can lower LDL levels from 10 to 60 percent, depending on the drug and dosage used. One landmark study completed in 1994, the Scandinavian Simvastatin Survival Study, found deaths from heart disease plummeted 42 percent, and deaths from all causes 30 percent, over five years in patients with heart disease who took Zocor. Several other studies found that Pravachol reduced heart attacks, surgical bypass, and angioplasties in patients without heart disease by lowering LDL levels. And one study found the drug reduced overall deaths in patients who had had a previous heart attack but who had cholesterol levels that were more or less average for the general population. New statins currently under development can lower LDL levels even more -- up to 80 percent in some cases -- garnering them the moniker "super statins."
Given their tremendous success, it's no wonder that statins are among the most frequently prescribed drugs in the United States (Lipitor is prescribed more than any other drug in America). Approximately 12 million Americans take statins. That's a small fraction of the estimated 36 million that doctors believe are eligible for the drugs based on guidelines set by the National Institutes of Health. In fact, some experts suspect that within a few years, half of all American adults will be taking statins, which some call the "drug of the century."
Such faith in the drugs is fueled in part by a British study, published in the medical journal Lancet, which concluded that just about anyone, of any age and at any risk for heart disease, could benefit from statins. And as you'll see in a minute, researchers are finding a plethora of benefits to statins that extend far beyond your cholesterol level. Statins, the researchers wrote, are the "new aspirin."
Statins generally take between four to six weeks to reach their maximum effectiveness. Dosages for statins vary depending on the drug, but at least one dose will be taken at dinner or bedtime because the body manufactures more cholesterol at night than during the day.
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