Cholesterol Medications (Statins)

Atorvastatin (Lipitor, Torvast)
Fluvastatin (Lescol, Lescol XL)
Lovastatin (Mevacor, Altocor)
Mevastatin
Pitavastatin (Livalo, Pitava)
Pravastatin (Pravachol, Selektine)
Rosuvastatin calcium (Crestor)
Simvastatin (Zocor, Lipex)
Simvastatin & Ezetimibe (Vytorin)
Lovastatin & Niacin (Advicor)
Atorvastatin & Amlodipine (Caduet)

What are statins and why are they used in the treatment of lupus?

Statins are medications that lower the level of cholesterol in your blood by reducing the production of cholesterol in the liver. Cholesterol is a natural component of the fats in your blood stream and the cells of your body. However, people with high levels of cholesterol in their blood (a condition known as hypercholesterolemia) face an increased risk of cardiovascular disease, which can lead to chest pain, heart attack, stroke, and peripheral vascular disease.

When too much cholesterol circulates in the blood, the substance can cause deposits (plaque) to form on your artery walls. Plaque is dangerous because it can block the flow of blood to various parts of your body, including your heart and brain. Studies have shown that people with lupus are more likely to have clogged arteries that can lead to heart attack and stroke at a younger age. This increased risk is caused by elevated cholesterol levels, high blood pressure, diabetes, and inflammation, conditions that occur often in people with lupus. Certain medications, such as corticosteroids (e.g., prednisone) can provoke or compound these symptoms. For this reason, the cholesterol-lowering properties of statins are commonly called upon for lupus patients.

How do statins work?

Statins work by blocking the enzyme in the liver that is responsible for making cholesterol. This enzyme is called HMG-CoA reductase, so statins are referred to by scientists as HMG-coA reductase inhibitors. By reducing the production of cholesterol by the liver, statins slow the formation of new plaques and reduce the size of plaques that may already exist. Statins also help to stabilize plaques and make them less likely to rupture and form clots. New research also shows that statins reduce inflammation in arterial walls, which is important for people with lupus, since they are more likely to have clogged arteries due to inflammation caused by the disease.

What else should I know about atherosclerosis and statins?

Statins are used specificially for preventing and treating atherosclerosis (the progressive narrowing and hardening of the blood vessels over time) that causes chest pain, heart attacks, strokes, and intermittent claudication (pain/cramping in the lower leg due to inadequate blood flow). Lupus, medications such as corticosteroids, family history, and other factors can predispose a person to atherosclerosis; however, only your doctor can decide whether statins are the right choice for you based on your total cholesterol level, LDL (“bad cholesterol”) level, and other risk factors. Most people are placed on statins only if lifestyle changes are not sufficient enough in reducing their cholesterol levels. However, keep in mind that if you begin taking a statin, you may be on it for the rest of your life.

Many people are surprised by the fact that cardiovascular disease—and not lupus itself—is the number one cause of death in people with lupus. Therefore, lifestyle changes are absolutely essential for reducing your risk of heart disease, whether you take a statin or not. In fact, lifestyle changes may have an even greater impact than medication alone on reducing your risk of cardiovascular disease. Quitting smoking is very important in reducing your risk of cardiovascular disease. Not only does smoking up your chance of heart attack, stroke, and other complications, but it also promotes lupus activity—smoking and lupus are not a good combination. In addition, reducing your alcohol intake can also lessen your risk of cardiovascular disease and improve the health of your liver. This change is especially important for people taking statins, since these medications can cause damage to your liver if not monitored properly.

Eating a low-fat, low-calorie diet is also essential in preventing or slowing atherosclerosis. Focus on what you can eat, not what you can’t. For example, fish, vegetables, fruits, whole grains, and legumes are all great choices. In addition, try to limit stress and exercise regularly. Walking, biking, stretching, yoga, and Tai chi are all great activities for people with lupus because they are easier on your joints but help to improve muscle, bone, and heart health. If you are overweight, weight loss can help to reduce your cholesterol.

What should I know about statins and autoimmune disease?

Studies done over the past few years have indicated that statins may rarely cause drug-induced lupus and other auto-immune conditions. Most of theses cases were caused by so-called “second generation” statins, such as simvastatin (Zocor, Lipex), atorvastatin (Lipitor, Torvast), and pravastatin (Pravachol, Selektine). Because of this rare side effect, it is important that you speak with your doctor about whether a statin is the appropriate medication for your condition.

What are the potential side effects of statin therapy?

Statins are tolerated well by most people, but they are associated with some side effects. Some of these side effects will go away as your body adjusts to the medication. Side effects include muscle and joint aches, nausea, diarrhea, and constipation. In addition, statins are associated with two potentially serious side effects, liver damage and muscle problems.

People who take statins should have periodic liver function tests, because occasionally statins can cause an increase in liver enzymes. If this increase is slight, you can continue with your recommended statin therapy. However, if it is high, your doctor will most likely recommend that you discontinue taking the medication, since increased liver enzymes can lead to permanent damage. Certain drugs can increase the risk of liver damage in people taking statins; these medications include gemfibrozil (Lopid) and niacin, so talk to your doctor if you take either of these medications.

In addition, statins may increase muscle pain, tenderness, or weakness; this side effect increases as your dose of statin goes up. In certain cases, muscle cells can break down and release a protein into the blood called myoglobin, which can cause damage to the kidneys. Certain medications—namely, gemfibrozil, erythromycin (Erythrocin), antifungal medications, nefazodone (Serzone), cyclosporine, and niacin—increase the risk of this side effect, so speak to your doctor if you take these medications or experience any muscle aches, tenderness, or weakness during statin therapy.

Are statins safe during pregnancy?

Statins are classified by the FDA as category X, which means they are never allowed in women who are pregnant or planning to become pregnant. Category X medications have been linked to fetal abnormalities in animal and/or human studies, and the FDA has stated that the risks of taking these medications during pregnancy outweigh the benefits. Specifically, statins block the formation of cholesterol, which is needed for the fetus to properly develop, so statin use during pregnancy can lead to birth defects. In addition, statins are not advised for women who are breastfeeding, since the drug may pass through breastmilk and harm the baby.