Statins for Familial Hypercholesterolemia
Those with high LDL cholesterol, familial hypercholesterolemia (FH), or high lipoprotein(a), also known as Lp(a), usually take LDL cholesterol-lowering medications to manage their cholesterol. The first-line (initial) treatment and most common type of medications are statins.
Statins block a key enzyme in the liver that leads to the production of cholesterol. When this enzyme is blocked, it reduces the amount of cholesterol made in the liver, and helps the liver remove LDL cholesterol that’s already in the bloodstream.
Studies have shown that statins can reduce LDL-cholesterol by 35 to 55% and can reduce the risk of cardiovascular disease by 22% for each 40 mg/dL reduction in LDL cholesterol.
Types of Statins
There are seven statin medications available. Individuals with LDL cholesterol levels over 190 mg/dL, including those with FH, and anyone with cardiovascular disease should be prescribed high-intensity statins because of their very high LDL cholesterol.
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The Truth About Statins
Statins are one of the longest and most well-studied drugs in medicine. We know that statins not only reduce LDL, but reduce the risk for heart attack, stroke, the need for stents or bypass surgery, and even death. However, there is a lot of misinformation out there about statins, so here’s the truth about this medication.
There can be side effects, but there are options.
Most people do not experience side effects from statins. If you do experience side effects from one statin, you are likely to find a different statin and/or a different dose that works for you. If you cannot find a statin that works for you, there are other treatment options.
About 10% of people report some side effects from a statin. These are typically muscle aches or pain. In general, most people can either tolerate the discomfort or find another statin or dose that works for them.
However, some less common side effects are more serious. One type of pain is called, myopathy, where there is muscle pain and evidence of muscle cell injury shown by elevations in muscle enzymes (CPK). The other is rhabdomyolysis, where muscle cells are rapidly destroyed. Muscle cell breakdown leads to release of a protein called myoglobin. Myoglobin can lead to kidney damage.
Just because these are well-known side effects, does not mean they are common.
Studies show myopathy occurs in less than 1 in 1000 patients. Rhabdomyolysis is even more rare and typically happens when the statin interacts other drugs. It can also occur in people with certain underlying medical issues like untreated hypothyroidism.
If you experience muscle pain, it will likely end if you change your statin, your dose, or stop taking it altogether. We strongly recommend discussing your symptoms with your healthcare provider before changing your dose or stopping your statin.
Having muscle pain with one statin does not mean you will feel this pain on every statin – in fact, you should discuss switching to another statin with your health care provider as your body may react differently to each statin.
In the past, healthcare providers routinely checked liver function tests in people on statins. Today, after statins are started, they may check your liver function in 6 to 12 weeks. As long as they’re normal, they’ll check them less often. If you have muscle-related symptoms it’s important to check your CPK, not your liver enzymes.
Statins have a small relationship to diabetes.
Being prescribed a statin does increase the chance of developing diabetes in the future. This generally only occurs in people who already have pre-diabetes. However, the benefit of the statin outweighs the very small risk of developing diabetes. When you begin a statin your healthcare provider will monitor your blood sugar, especially if you have pre-diabetes.
Statins are safe for children.
Both the American Heart Association and the American Academy of Pediatrics have recommended statins for children with lipid disorders like FH. They can begin treatment as early as 8 years old. Studies have shown when children with FH begin a low-dose statin between 8 and 10 years old, they a lower incidence of cardiovascular disease. In fact, disease rates have been shown to be close to that of the normal population over 40 years of follow up!
Studies in children suggest less side effects than in adults, in fact they rarely occur in this age group.
In the almost 40 years since statins have been available, no long term safety issues have been identified.
Before taking a statin:
- Check for interactions with drugs you are already taking.
- Severe muscle pain or weakness should be reported to your doctor right away.
- The most current guidance from the FDA says it is acceptable for a woman to continue her statin until she has a positive pregnancy test. It is not advised, though, that women take statins during pregnancy or while nursing.