Don’t assume it is the same as your first statin.
Statins revolutionized treatment for high cholesterol in the 1980s. Today, there are several types of statins that may help manage your cholesterol levels when heart-healthy lifestyle changes aren’t enough. Sometimes, the first statin your doctor prescribes might not be the right fit. In this case, you might try a second-line statin.
“If a patient's been prescribed a statin and they're not reaching their targets, there are a couple of things that we want to do,” says Lawrence Phillips, MD, cardiologist at NYU Langone Health. “Do we need to go up on the medication dose or change to a different medication within the same class? Or do we need to add another medication on board to get them to their goal?”
What Are Statins?
Statins serve two main functions: They decrease your body’s own production of cholesterol, and they help remove cholesterol in the liver. These two functions combined help reduce LDL (bad) cholesterol levels to safer levels, thus reducing your risk of heart attack and stroke. Patients tend to tolerate statin medicines well and see promising results, so statins are often the first-line treatment against high cholesterol.
“Second-line statin” is just a fancy way of saying the first statin you tried wasn’t the right fit. It means the first-line treatment either didn’t reduce cholesterol levels enough, despite you taking it as prescribed and making lifestyle changes.
“Another time where we'll change a patient from one statin to another is when they're having side effects, such as muscle aches. We'd like to try two statins to make sure that we're able to tolerate at least one of them before moving on to other classes of medications,” says Dr. Phillips.
Getting to Know Your New Statin
You might be thinking, If one statin didn't work for me, why would I try another? It’s important to remember that not all statins are the same. “Within the class of medications of statins, there's a difference enough in their pathway that some patients are able to tolerate some and not others,” says Dr. Phillips.
As a result, you need to understand your new statin well—and not assume that it’s going to be the same as your first statin. When you’re getting a second-line statin, consider asking your doctor the following questions:
- Why do you recommend this statin?
- How is this different from my first statin?
- What side effects should I expect?
- How long should I expect to take this statin?
- How will I know if this statin is working?
- What are my options if this second-line statin doesn’t work either?
“When a patient is not able to tolerate one medication and expresses frustration, the first thing to do is to reassure them that this is very common and that we have many different options that we can use in medications, both within the statin class and others, but in the great majority of patients, if we work together, we can reach our target,” says Dr. Phillips.
Lawrence Phillips, MD, is a cardiologist at NYU Langone Health. Dr. Phillips is the assistant professor of the Department of Medicine at NYU Grossman School of Medicine, the assistant clinical director for strategic affairs at Leon H. Charney Division of Cardiology, the director of the Nuclear Cardiology Laboratory, the medical director for Outpatient Clinical Cardiology, and the associate director of the Cardiovascular Disease Fellowship Program.
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When starting on medication, it's common
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that we need to switch between medications
in the same class.
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So for statin medications,
somebody might be started on one,
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and either because of side effects
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or because of the potency or power of it,
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they need to change to another one.
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Our goal is the same:
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to make sure to reduce the cholesterol values,
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at the same time as minimizing any side effects
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because the goal is to decrease patients' risk
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over the long term.
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If a patient is placed on a cholesterol medication
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such as a statin, and they're not able
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to reach their target,
we'll often change them
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to another more potent statin medication first
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to try and optimize the use of one medication,
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rather than needing several.
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Another time where we'll change a patient
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from one statin to another
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is when they're having side effects
such as muscle aches.
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We'd like to try two statins to make sure
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that we're able to tolerate at least one of them
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before moving on to other classes of medications.
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There's a difference enough in their pathway
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that some patients are able to tolerate some
and not others.
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We know that when we start a patient on a medication
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such as a statin
that we have a goal in mind.
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The goal can be both numerical,
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meaning to get their cholesterol numbers
to a certain amount
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but also the goal is to reduce events
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like heart attacks or strokes over a long time.
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So even early on, it's important that the patients
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be compliant because we're looking at a longitudinal
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or a long-term interaction and reduction of risk.
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I encourage all patients to ask questions
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when they see their doctors.
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First, they should know their numbers.
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What are the test results?
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It's not enough to be told your cholesterol is high.
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Learn what that means
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so that when you see improvement,
you can see that validation.
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The second thing they should ask
for any medication
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they're starting on, is what are the side effects?
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What should I be looking for?
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And the third is,
how am I going to deem this successful?
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What are my outcome measures?
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How will I know that we've done well together?
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- Endo A. A historical perspective on the discovery of statins. Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11;86(5):484-93.
- High cholesterol facts. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on September 15, 2020)
- Last AR, Ference JD, Menzel ER. Hyperlipidemia: drugs for cardiovascular risk reduction in adults. Am Fam Physician. 2017 Jan 15;95(2):78-87.
- Patient education: high cholesterol and lipid treatment options (beyond the basics). Waltham, MA: UpToDate, 2020. (Accessed on September 15, 2020)