Statins: What are they and how do they affect cholesterol?

Statins are one of the most commonly prescribed medications for the treatment of high cholesterol and the prevention of cardiovascular diseases. They are particularly known for their ability to lower blood LDL cholesterol, which is also referred to as "bad cholesterol." High levels of LDL cholesterol are a significant risk factor for heart diseases, as they can lead to the hardening and blockage of arteries, increasing the risk of heart attacks and strokes.

This article discusses what statins are, how they work, who benefits from their use, what side effects they may have, and what else is important to know about statins.

Statins are a class of medications that lower blood cholesterol levels by inhibiting the liver's ability to produce cholesterol. They have been in use for decades and have a well-established role in the prevention of cardiovascular diseases. Statins are prescribed particularly for those at increased risk of developing heart and vascular diseases due to high cholesterol, previous heart symptoms, or hereditary factors.

There are several different types of statins available, the most commonly used include:

•  Atorvastatin 

•  Simvastatin 

•  Rosuvastatin 

•  Lovastatin 

The effect of these medications is based on their ability to inhibit the activity of an enzyme called HMG-CoA reductase. This enzyme is crucial in the production of cholesterol in the liver, and when its activity is inhibited, the liver produces less cholesterol, which in turn reduces the amount of cholesterol in the bloodstream.

Statins primarily work by reducing the amount of LDL cholesterol in the blood. They inhibit the liver's cholesterol production, which leads to the liver removing more cholesterol from the bloodstream, particularly LDL cholesterol. As the level of LDL cholesterol in the blood decreases, the risk of heart and vascular diseases also decreases.

Additionally, statins have other effects that may protect heart health:

•  Reducing inflammation in the arteries: Statins can reduce inflammation in the arteries, which is associated with the development of atherosclerosis or hardening of the arteries.

•  Stabilization of plaques: Plaque buildup in the arterial walls caused by atherosclerosis can rupture, leading to the formation of blood clots and increasing the risk of heart attack. Statins can help stabilize these plaques, reducing their risk of rupture.

•  Prevention of blood clotting: Although statins are not primarily blood thinners, they may have a mild effect on reducing blood clotting, which decreases the risk of blood clots forming.

Statins are primarily prescribed for individuals at high risk of developing cardiovascular diseases.These groups include, for example:

•  Individuals with high LDL cholesterol: Statins are an effective way to lower high cholesterol levels, especially if lifestyle changes, such as improving diet and increasing exercise, are not sufficient.

•  Individuals at risk of cardiovascular diseases: If a person has multiple risk factors, such as high blood pressure, diabetes, smoking, or obesity, statins may be part of preventive treatment to reduce the risk of heart disease.

•  Those who have previously had a heart attack or stroke: Statins are often prescribed for those who have already experienced a cardiovascular event to reduce the risk of new events.

•  Individuals with familial hypercholesterolemia: This genetic condition causes extremely high cholesterol levels, and statins are a common treatment method for managing this condition.

Statins can lower LDL cholesterol by up to 50%, making them a very effective treatment for high cholesterol. Together with a healthy diet, exercise, and other lifestyle changes, they can help achieve a healthy cholesterol balance.

Although statins are effective in lowering LDL cholesterol, they can also increase the levels of good cholesterol, namely HDL cholesterol, and lower blood triglyceride levels, which enhances their benefits for heart health.

Although statins are generally well tolerated, they can have side effects. It is important for patients to monitor their condition during statin therapy and report any possible adverse effects to their doctor. The most common side effects include:

One of the most common side effects of statins is muscle pain or weakness. Symptoms can range from mild discomfort to severe muscle pain. In rare cases, statins can cause a serious condition called rhabdomyolysis, where muscle cells break down and release toxic substances into the bloodstream. Rhabdomyolysis is extremely rare, but it can be dangerous if not treated promptly.

Statins can affect the liver and raise liver values (ALAT, ASAT). Although a mild increase in liver values is generally not dangerous, doctors monitor the liver function of patients using statins to ensure that no liver damage occurs. However, serious liver damage from statins is rare.

The use of statins may be associated with a slight increase in blood sugar, and in some individuals, they may increase the risk of type 2 diabetes. However, this effect is usually very small, and often the risks are lower than the benefits gained from preventing heart disease.

In some cases, patients using statins have reported memory problems or confusion.These cases are rare, and most symptoms disappear after discontinuing the medication. Studies have not shown a direct link between statins and serious cognitive problems.

Although statins are effective medications for lowering cholesterol, they do not replace a healthy lifestyle. Patients who use statins still benefit from healthy dietary choices, regular exercise, and other heart health-promoting habits.

Statins work best when combined with:

•  A diet low in saturated fats and trans fats 

•  Regular exercise: At least 150 minutes of moderate exercise per week

•  Weight management: Being overweight can increase LDL cholesterol and the risk of heart disease

•  Quitting smoking: Smoking damages blood vessels and increases the risk of heart attack

Statins are an effective and safe way to lower LDL cholesterol and reduce the risk of cardiovascular diseases.They inhibit the liver's cholesterol production and provide the additional benefits of anti-inflammatory and plaque-stabilizing effects, which protect the arteries and heart.

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