Your doctor may have told you that your blood cholesterol levels are high. This increases your risk of serious diseases like heart attack and stroke. One of the best ways to reduce this risk is to control your cholesterol levels. The most common type of medication prescribed by doctors for this is called a statin. But sometimes, even taking these medications doesn't give you the results you want. A study found that half of people taking statins still haven't been able to lower their cholesterol to a healthy level after two years. So, if that's you, what should you do?
Heart disease risk
Check the risk of developing a heart disease within the next 10 years with the Framingham Score
Why do statins sometimes not work properly?
When your cholesterol doesn't go down despite taking a statin, some doctors call this 'statin resistance.' But this condition is actually very rare. If you're taking your medication correctly, it's hard to believe it's not working at all. But it could be that it's not working well enough. Here are some reasons why you might not be getting the results you're hoping for.
| Possible reason | Simple explanation |
|---|---|
| Not taking the medicine properly | First, ask yourself, "Am I taking my medication exactly as the doctor told me, at the right time?" If you're forgetting a day or skipping a day, that could be the main reason why your cholesterol isn't going down. |
| Side effects | Some people experience side effects (e.g. muscle pain) that are difficult to tolerate from statins. If this is why you are avoiding taking your medication, be sure to talk to your doctor about it. |
| Medicine alone is not enough | If your cholesterol levels were very high to begin with, statin drugs alone may not be enough to lower them. You may need to consider other options. |
| Unhealthy diet | If you eat a lot of foods high in saturated fats (oily foods, red meat, high-fat dairy products), it's difficult for statins alone to lower cholesterol. A heart-healthy diet is essential. |
| It will take a little longer. | Statins are not an instant drug. If you just started taking them, your doctor will usually check to see if your cholesterol has decreased after about 2 months. Be patient. |
| Insufficient dose | It may be that the dose you have been prescribed is not enough. Your doctor may suggest increasing the dose slightly. |
| Other health problems | If you have problems with your thyroid, liver, or kidneys, your cholesterol can also be high. Your doctor will do blood and urine tests to check for these. |
| Other medications | Some other medications you take can interfere with the action of statins. Tell your doctor about all the medications you take (even vitamins and supplements) . |
| Genetic causes (Genes) | Although very rare, there are cases where people do not respond to statins due to certain genetic changes. However, the most important thing is to find a way to lower cholesterol. |
If statins don't work, what are the other options?
If your doctor can't find a way to control your cholesterol with statins, there are other medications you can try. First, you can try a different type of statin. But remember that they all work in the same way.
If you can't take statins, or if they don't work, your doctor may prescribe a different class of cholesterol-lowering medication. These are medications that work differently.
Important: Do not use any of these medications without consulting your doctor. This information is for your information only.
| Drug category | How it works |
|---|---|
| Bile acid sequestrants | It prevents the body from absorbing the fat in the food we eat. |
| Cholesterol absorption inhibitors | It stops the body from absorbing cholesterol from food. |
| Niacin (nicotinic acid) | Helps reduce bad cholesterol (LDL). |
| PCSK9 inhibitors | It blocks a special protein and helps the liver remove bad cholesterol (LDL). |
| Fibrates | It can increase good cholesterol (HDL) levels. |
| ACL inhibitors | They work differently than statins by stopping the liver from making cholesterol. For example, Bempedoic acid (Nexletol). |
Treatment for rare genetic conditions
If your high cholesterol is caused by a rare genetic condition like familial hypercholesterolemia, there are other specific treatments available. For example, Lipoprotein apheresis (a process that removes bad cholesterol from the blood), specific medications like Lomitapide and Mipomersen (Kynamro), and in some cases, a liver transplant may be necessary. These are decided by your specialist.
Let's change not only medicine, but also lifestyle!
Whether you take statins or not, don't forget that a good diet and exercise are essential to maintaining healthy cholesterol levels. If statins aren't having the desired effects, you may want to reconsider what you're eating and drinking.
Things to avoid:
- Saturated fat: Red meat, full-fat dairy products, and foods deep-fried in oil.
- Trans fats: These can be found in margarine, some packaged foods, and bakery products.
Things to eat more of:
- Omega-3 fatty acids: Oily fish like salmon, mackerel, and herring, flax seeds, and nuts like walnuts.
- Fiber: Oats, barley, beans, lentils, fresh fruits and vegetables.
- Whey protein: A healthy protein found in dairy products.
In addition to this diet control, living an active lifestyle can increase your good cholesterol (HDL) levels . Also,
- Quitting smoking
- Losing weight
- Limiting alcohol consumption
Things like that are also a great help in controlling your cholesterol levels.
Think about your risk too.
Your doctor may have given you a specific cholesterol goal. If you're still not reaching that goal even with a statin, you need to consider your other risk factors for heart disease. As your risk increases, your doctor may recommend more aggressive measures to lower your cholesterol.
For example, if you have already had a heart attack or stroke , it is very important to lower your cholesterol. It is also very important if you have other risk factors (such as diabetes or high blood pressure) in addition to cholesterol. Your doctor can help you understand your risks and what you need to do to protect your health.
💡 Take-Home Message
- Take your statin medication exactly as prescribed by your doctor, in the correct dosage, and on time. Never stop taking it arbitrarily.
- If you experience any side effects from your medication, instead of stopping it, talk to your doctor about it. You may be able to switch to a different medication.
- Medication alone is not enough. A heart-healthy diet and daily exercise are essential for controlling cholesterol.
- If statins alone are not enough to control your cholesterol, don't worry. There are a number of other medications that can help.
- Always discuss your treatment plan and risk factors with your doctor, and together you can make the best decisions.
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