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Statins; duration of use and cholesterol targets

 

Statins are drugs used in reducing cholesterol level in the blood. They work by preventing the production of cholesterol by the liver and by the removal of cholesterol from plaques, which are cholesterol deposits in blood vessels that block the flow of blood. In this way they help in preventing heart attack and stroke. Examples of these drugs include Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin).

The frequently asked question about Statins is how long am I going to take this drug? The answer I give is that Statins are taken for long term. However, it depends on the reason for starting the drug in the first place, the response of your body to the drug and whether the patient is able to comply with the recommended diet and exercise regimen. If the reason for starting the drug is after a heart attack or stroke or any other cardiovascular event, then the treatment is lifelong. If you have a genetic problem in which your bad cholesterol (LDL) is very high (>190 mg/dl) as in familial hypercholesterolaemia then you will be put on a lifelong treatment with Statins. For most other reasons you have to weigh the risk of the adverse effects of the drugs to the benefit of treatment. Abundance of risk factors for cardiovascular disease such as, diabetes, hypertension, smoking, obesity in an individual will weigh towards lifelong treatment with Statins. Noncompliance to recommended diet and exercise regime will also weigh towards lifelong treatment. For patients with less risk factors and high cholesterol, most doctors will want to repeat the blood cholesterol after 3 months of treatment. Statins normally takes about 6 weeks to stabilize blood cholesterol level. However note there is no duration of time to stop the cholesterol medication. The doctor will weigh the pros and cons, whether you are complying with diet and exercise, whether you have achieved the target blood cholesterol level before deciding if it is safe for you to stop the medication.

The target cholesterol levels to be achieved differ depending on the health condition of the individual. The American College of Cardiology and American Heart Association new recommendation for patients, who already have cardiovascular disease, is a target level for LDL, bad cholesterol of 70 mg/dl. And for otherwise healthy individuals with high cholesterol, the target should be 100 mg/dl.

Note, not all patients with high cholesterol need Statins; some can be treated with only diet and exercise, especially if there is no evidence of cardiovascular disease and the risk for CVD is low. You should always have a frank discussion with your doctor.

About Dr Emeka Okocha

Consultant Cardiologist with interest in preventive cardiology

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