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Medication for the treatment of high cholesterol levels

Last Update: August 29, 2013; Next update: 2016.

High cholesterol levels could mean an increased risk of cardiovascular disease. Certain medications that reduce cholesterol levels can prevent related health problems and increase life expectancy. Whether or not it is worth taking these medications will depend on what other risk factors you have.

If the risk of cardiovascular disease cannot be reduced enough through general measures, treatment with medication can be considered. Whether or not it is worth taking medication will vary from person to person, depending on what other risk factors for cardiovascular disease they have and how important the advantages and disadvantages are to them.

People’s individual approach to health will play a role too. If someone has unfavorable cholesterol levels but they do not have any other risk factors, or only a few, then they might prefer not to take medication. People who have several other risk factors might be more concerned so they might be more willing to take medication.

When deciding whether or not to have a certain treatment, it can help to know what advantages and disadvantages the treatment has. Various groups of drugs can reduce cholesterol levels. But only one group of drugs, known as statins, has been well studied for the treatment of people who have never had a heart attack, stroke or other type of cardiovascular disease. Statins lower the risk of vascular disease by about 20% in these people. The health impact of this risk reduction will vary from person to person, though, mostly depending on their individual risk of cardiovascular disease. A doctor can help you determine your personal risk.

Already having cardiovascular problems such as coronary artery disease is one major factor. If that is the case, it greatly increases the risk of heart attack or stroke. Medication can be used to reduce this risk very effectively.

Benefits of taking statins and personal risk of cardiovascular disease

The following table might make it clearer why other risk factors have to be considered too. It describes two men and two women who are at “low” or “high” risk of cardiovascular disease. “Low risk” means they have unfavorable cholesterol levels only. “High risk” means they have unfavorable cholesterol levels as well as other risk factors for cardiovascular disease. These include things like smoking, high blood pressure and diabetes. The number in the first column indicates how many out of 100 people will have a heart attack or stroke within the next ten years if they do not take statins. The number in the second column indicates how many people will have one of these cardiovascular events within the next ten years if they take statins during that time. The third column shows the difference between the two groups – in other words, the number of people that statins will prevent heart attacks or strokes in.

Table: Risk of having a heart attack or stroke within the next ten years

 Without statinsWith statinsHeart attack
or stroke prevented in
Woman - low risk4 out of 1003 out of 1001 out of 100
Woman - high risk18 out of 10014 out of 1004 out of 100
Man - low risk11 out of 1009 out of 1002 out of 100
Man - high risk33 out of 10026 out of 1007 out of 100

The table makes it clearer that women and men who have a higher cardiovascular risk benefit more from statins than those who have a low risk. As a basic rule, the higher your risk of cardiovascular disease, the more likely you are to benefit from taking statins. But it is not possible to predict who will benefit from the treatment and who will not.

Side effects

The more common side effects of statins include gastrointestinal problems (stomach and bowel problems) such as constipation, flatulence and nausea. More than 1 out of 100 people who take statins have this kind of side effect. Headaches and sleep problems are about as common as these gastrointestinal problems. Statins can also cause muscle ache and muscle inflammation. But they are well tolerated by most people.

Rhabdomyolysis is an extremely rare but serious side effect where muscle tissue gradually breaks down in certain muscles. This can lead to permanent paralysis, and the breakdown products can cause serious kidney damage. In studies, rhabdomyolysis was found to occur in 1 out of 10,000 people who took statins for longer periods of time. Signs of this side effect include muscle ache and dark-colored urine, so it is important to seek medical advice if you have these symptoms.

Statins can also lead to an increase in blood sugar levels. In studies, statins were found to lead to high blood sugar levels in 1 out of 1,000 people per year. But it is not clear whether this affects their health.

The following statins have been licensed for use in Germany: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin.

Many people would rather not have to take medication regularly over longer periods of time. They might worry that leftover medication will build up in their body. But fears like this are unfounded: our bodies continuously break down and get rid of medications with the help of various mechanisms.

Sources

  • Absolutes und relatives Risiko – individuelle Beratung in der Allgemeinpraxis (Arriba). Arriba Herz Risikokalkulationsbogen. [Accessed on May 8, 2012].
  • Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes EH et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380(9841): 581-590. [PMC free article: PMC3437972] [PubMed: 22607822]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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