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Statins are used to control high cholesterol. Your body needs this fatty substance to function. Every cell in your body uses cholesterol to build the membrane in its outer wall. Cholesterol is made in the liver, but can also be found in some foods. Cholesterol is transported around the body by proteins. When cholesterol and proteins combine, they're known as lipoproteins.

• High-density Lipoprotein (HDL) or good cholesterol: HDL returns cholesterol away from the cells back to the liver. Once it arrives there, it's either broken down or passed out of the body as a waste product. For this reason, HDL is described as good cholesterol.
• Low-density Lipoprotein (LDL) or bad cholesterol: High rates of bad cholesterol (LDL or low-density lipoprotein) can be dangerous because it can lead to a hardening or narrowing of the arteries. LDL is taken to cells that need it, but if there's too much cholesterol, it builds up in the artery walls, causing disease of the arteries. This can slow or block the flow of blood to the brain or heart or the rest of your body and this increases the risk of serious conditions like coronary heart disease (where blood flow to the heart is restricted), heart attack and stroke. It also increases the risk of developing a blood clot elsewhere in your body. When we talk about high cholesterol, we mean high levels of Low-Density Lipoprotein or bad cholesterol.

Statins block a chemical that helps to make cholesterol in your liver. Taking statins means that less cholesterol is produced by the liver. This results in lower cholesterol levels in the blood. There are many different types of statins. Most commonly, GPs ask people to start with simvastatin (brand name Zocor). Depending how you get on with this medication and whether you experience any side effects, there are other types of statins that you can try. These include: atorvastatin (brand name Lipitor) and rosuvastatin (brand name Crestor). Reducing cholesterol is an important step in maintaining your health and preventing dangerous complications.

Most statins come as tablets. It’s important to take them regularly as outlined on the prescription. Often statins should be taken at night because this is when the liver produces most cholesterol. If you’re not sure, read the patient information leaflet that came with your treatment, or check with your doctor or pharmacist.

All statins do the same thing. They all block a step in the liver’s production of cholesterol. They all reduce the levels of cholesterol in the blood – especially the levels of bad cholesterol. Often, people don’t need a very strong statin to lower their cholesterol levels. If you experience side effects or an intolerance to one type of statin, you might find that a different one works much better. Speak to your doctor about the right statin for you.

Drinking a glass of grapefruit juice or eating grapefruit while taking certain types of statins can make side effects more likely. This is because there’s a chemical in grapefruit that can increase the levels of certain statins in the blood, meaning that you end up having a higher dose in your body.

This is most likely to happen with simvastatin, so you should avoid grapefruit completely if you use this. Occasional grapefruit juice with atorvastatin is less of a problem, but in large quantities it can be unsafe. Other types of statins are not affected by grapefruit.

Alcohol and statins can both damage your liver. You should not drink excessively while you're taking statins and discuss any regular alcohol consumption with a doctor, to make sure you're not causing any damage to your liver. When you start treatment with statins, please read the patient leaflet for detailed information about your statin and alcohol.

Cholesterol can be measured with a blood test – either blood is taken with a syringe or by pricking your finger. There is not a set level of cholesterol that is recommended, because it varies depending on whether you’re healthy or at a high risk of heart disease.

The following factors increase your chances of having a heart attack or stroke as a result of high cholesterol:

• Family history of heart disease or stroke
• Family history of a genetic condition called familial hypercholesterolaemia (FH) – this can mean that even people who eat healthily get high cholesterol
• Being of Pakistani, Bangladeshi or Sri Lankan descent – people from these ethnic groups have a higher likelihood of getting high cholesterol
• Having diabetes, high blood pressure, kidney disease, liver disease, or an underactive thyroid can cause high cholesterol
• Age – as you get older your arteries are more likely to narrow (known as atherosclerosis)
• Lack of physical activity or exercise – can increase your cholesterol levels
• Obesity – being overweight means that you have higher levels of bad cholesterol and lower levels of good cholesterol. Losing weight can help you reduce your risk of cholesterol if you are obese or overweight
• Drinking lots of alcohol – can raise your cholesterol and triglyceride levels
• Eating an unhealthy diet – a diet that contains a lot of saturated fat can increase your overall cholesterol levels
• Smoking – cigarettes contain a chemical called acrolein which stops High-Density Lipoprotein (good cholesterol) from transporting Low-Density Lipoprotein (bad cholesterol) to the liver. This means that the bad cholesterol continues to build up in your arteries, which has the effect of narrowing them.

The first thing you should do to lower high cholesterol is to increase the amount of exercise you're doing and eat more healthily. If this does not work, your doctor will probably suggest trying medication.

A research paper published by the charity Heart UK found that with an identical dose, the statins atorvastatin and rosuvastatin lower bad cholesterol the most out of all five statins currently available in the UK. A single dose of atorvastatin and rosuvastatin lasts longer than a single dose of other types of statins. This also means that they can be taken at any time of day, whereas normally statins need to be taken at night because this is when the liver produces most cholesterol.

Clinical evidence is strongest for simvastatin, pravastatin and atorvastatin because it has been tested on the most patients and has very clear benefits. The longer term benefits of fluvastatin and rosuvastatin are less clear.

Simvastatin and pravastatin are made by generic manufacturers and so are now significantly cheaper than other brands of statins.

Some of the steps you can take to lower your cholesterol can also lower your levels of triglycerides – another type of fatty substance found in the blood which is produced by the liver and found in dairy, meat or cooking oils.

The first thing you should do to lower high cholesterol is increase the amount of exercise you're doing and eat more healthily. If this does not work, then your doctor will suggest trying medication.

To change your diet, you should look to eat much less saturated fat. Men should eat less than 30g of saturated fat a day. Women should eat less than 20 g of saturated fat a day.

Check the labels of the food you're eating to work out how much saturated fat is in your food, but try to avoid:

• fatty meats or meat products (sausages and pies, for example)
• butter
• ghee
• lard
• cream
• soured cream
• crème fraiche and ice cream
• cheese – especially hard cheese
• cake and biscuits
• chocolate
• coconut oil
• coconut cream
• palm oil

You can also start to eat more food that is high in omega-3 fatty acids. Experts believe that eating fish like tuna, mackerel, and salmon can lower triglyceride levels.

There are different types of medication available to lower your cholesterol levels. These include statins (statins block the enzyme that helps to make cholesterol in your liver – so that cholesterol levels fall), aspirin (prevents blood clots forming), niacin, and ezetimibe.

Niacin is a B vitamin found in foods and vitamin supplements. In high doses, Niacin can reduce levels of bad cholesterol. Niacin can cause side effects, particularly flushing or going red in the face. It can also damage your liver if you take it for a long time. For this reason, it's not used very often.

Ezetimibe is medication that stops your body absorbing cholesterol and bile juices from the intestines into your blood.

It's generally not as effective as statins, but it rarely has side effects and so some people prefer to try it – especially if they cannot take statins because of another condition or their other medication.

You can also combine ezetimibe with your statins, if your cholesterol is refusing to drop low enough with the statin on its own. Using the two drugs in combination usually results in the same side effects as those caused by statins alone – primarily muscle pain and stomach problems. Talk to your doctor if you'd like to try this.

There are many different types of statins. The five types available in the UK are:

• simvastatin (brand name Zocor)
• atorvastatin (brand name Lipitor)
• rosuvastatin (brand name Crestor)
• pravastatin (brand name Lipostat)
• fluvastatin (brand name Lescol)

All statins do the same thing. They all block a step in the liver’s production of cholesterol. They all reduce the levels of cholesterol in the blood, especially the levels of bad cholesterol.

Simvastatin and pravastatin are made by generic manufacturers and so are now significantly cheaper than other brands of statins.

Often people don’t need a very strong statin to lower their cholesterol levels. If you experience side effects or an intolerance to one type of statin, you might find that a different one works much better. Speak to your doctor about the right statin for you.

Statins aren’t the right choice for everyone and some people should never take them. Other people can use them, but must be careful in doing so. Statin side effects can include a range of conditions. Always read the patient leaflet of your medication to ensure you're able to spot any side effects and are aware of any warnings and risks.

You need to speak to your doctor about extra precautions taking Simvastatin (brand name Zocor), because it may not be suitable for you, if you:

• are going to have surgery soon
• are older than 65 years
• are allergic/sensitive/have reacted badly to a statin or fibrate previously
• are allergic to any of the ingredients in the medicine
• are breast-feeding
• are female
• are pregnant (simvastatin must not be taken in pregnancy)
• drink a lot of alcohol
• are galactose intolerant or have problems with glucose-galactose malabsorption
• have hypothyroidism
• have kidney or liver problems
• have Lapp lactase deficiency
• have a family history of muscle disorders
• have or have had high blood pressure/hypertension
• have risk factors for rhabdomyolysis.
• This medication is often judged to be unsuitable for children under 10 years old, or children who have yet to hit puberty, or girls who have not yet started having their period.

Be sure to tell your doctor if you're taking vitamin supplements or:

• amiodarone
• amlodipine
• boceprevir
• ciclosporin
• clarithromycin
• colchicines
• danazol
• diltiazem
• erythromycin
• fenofibrate
• fluconazole
• fusidic acid
• gemfibrozil
• itraconazole
• ketoconazole
• nefazodone
• nelfinavir
• nicotinic acid
• posaconazole
• rifampicin
• telaprevir
• telithromycin
• verapamil

• Anticoagulants
• Calcium channel blockers
• Cytochrome P450 enzyme inducers
• Cytochrome P450 enzyme inhibitors
• Fibrates
• HIV protease inhibitors

Side effects are rare. But they include:

• abnormal laboratory test results
• blood problems
• constipation
• diarrhoea
• feeling dizzy
• flatulence
• hair loss
• headaches
• indigestion
• itching
• nausea
• damage to the nerves in your hands or feet, which can cause numbness, pain or weakness (peripheral neuropathy)
• pancreatitis
• paresthesia
• rhabdomyolysis
• skin rash or rashes
• stomach pain
• vomiting
• weakness
• liver problems – these can be fatal, so please get immediate medical advice if you develop jaundice
• muscle problems – these can also be fatal, so please see a doctor straight away if you get unexplained muscle pain, cramps, weakness, or tenderness

You need to speak to your doctor about extra precautions taking Atorvastatin (brand name Lipitor), because it may not be suitable for you, if you:

• could get pregnant and are not using an effective method of birth control
• are older than 70
• are allergic/reacted badly to a statin or a fibrate previously
• are allergic/reacted badly to any of the ingredients in the medicine previously
• are breast-feeding
• are pregnant
• drink a lot of alcohol
• are galactose intolerant
• have problems with glucose-galactose malabsorption
• have had a stroke
• have had transient ischaemic attacks
• have hypothyroidism
• have Lapp lactase deficiency
• have lung problems
• have or have a family history of muscle problems
• have or have had kidney or liver problems
• have risk factors for developing rhabdomyolysis
• are a child under 10 years old.

To figure out whether this might be the right medication for you, the doctor may also run some tests first.

Your body’s reaction to Lipitor can change with time. If this happens, contact your doctor straight away.

If you're taking any other medication or vitamin supplements be sure to tell the doctor when you ask for the prescription.

• Aluminium hydroxide
• Amiodarone
• Amlodipine
• Atazanavir
• Ciclosporin
• Cimetidine
• Clarithromycin
• Colestipol
• Darunavir
• Delavirdine
• Digoxin
• Diltiazem
• Efavirenz
• Erythromycin
• Ethinylestradiol
• Ezetimibe
• Fenofibrate
• Fluconazole
• Fosamprenavir
• Fusidic acid
• Gemfibrozil
• Indinavir
• Itraconazole
• Ketoconazole
• Lopinavir
• Magnesium hydroxide
• Nelfinavir
• Nicotinic acid
• Norethindrone
• Phenazone
• Posaconazole
• Rifampicin
• Ritonavir
• Saquinavir
• Stiripentol
• Telithromycin
• Tipranavir
• Verapamil
• Voriconazole
• Warfarin
• St John’s Wort

• Coumarin anticoagulants
• Cytochrome P450 enzyme inducers
• Cytochrome P450 enzyme inhibitors
• Fibrates
• Magnesium/aluminium hydroxide antacids
• Medicines that can cause muscle problems
• Oral contraceptives
• Protease inhibitors

The most common side effects for Lipitor were headache, stomach ache or stomach problems, and/or back ache.

More than 1 % of people who take Lipitor experience these side effects:

abnormal laboratory test results, allergic reactions, back pain, constipation, diarrhoea, flatulence, headaches, increased blood sugar levels, indigestion, joint swelling and joint pain, nausea, nose and throat inflammation, nose bleed, painful extremities, throat pain, muscle problems – sometimes with a high temperature or generally feeling unwell.

See a doctor straight away if you have muscle cramps, pain, or weakness, as they could be fatal.

Always read the patient information leaflet so that you also know about the less common side effects.

You need to speak to your doctor about extra precautions taking Rosuvastatin (brand name Crestor), because it may not be suitable for you, if you:

• could get pregnant and are not using an effective method of birth control
• are older than 70
• are allergic/reacted badly to any of the ingredients in the medicine previously
• are breast-feeding
• are of asian origin
• are pregnant
• are or have been at risk of developing diabetes
• are galactose intolerant
• have problems with glucose-galactose malabsorption
• have had muscular toxicity caused by a fibrate or a HMG-CoA reductase inhibitor
• have kidney problems or have conditions that may increase the risk of developing kidney problems
• have Lapp lactase deficiency
• have or have had high blood pressure
• have or have had liver problems
• have problems metabolising medicines
• have risk factors for developing muscle problems such as if you drink alcohol heavily, have hypothyroidism, have muscle disorders or have a family history of muscle disorders
• To figure out whether this might be the right medication for you, the doctor may also run some tests first.

If you're taking any other medication or vitamin supplements be sure to tell the doctor when you ask for the prescription.

• Baicalin
• Ciclosporin
• Darunavir/ritonavir
• Dronedarone
• Eltrombopag
• Erythromycin
• Ethinylestradiol
• Ezetimibe
• Fenofibrate
• Gemfibrozil
• Itraconazole
• Lopinavir
• Lopinavir/ritonavir
• Lopinavir/tipranavir
• Nicotinic acid
• Norgestrel
• Ritonavir/atazanavir
• Tipranavir
• Tipranavir/ritonavir
• Warfarin

• Aluminium/magnesium antacids
• Azole antifungal agents
• Coumarin anticoagulants
• Fibrates
• Hormone replacement therapy
• Lipid lowering agents
• Macrolides
• Oral contraceptives
• Protease inhibitors
• Vitamin K antagonists

• constipation
• diabetes
• muscle problems – See a doctor straight away if you get unexplained muscle pain, cramps, weakness or tenderness.
• feeling dizzy
• headaches
• nausea
• proteinuria
• stomach pain
• weakness

You need to speak to your doctor about extra precautions taking Pravastatin (brand name Lipostat), because it may not be suitable for you, if you:

• are older than 70
• are allergic or react badly to any of the ingredients in the medicine
• are breast-feeding
• are pregnant
• drink a lot of alcohol
• are galactose intolerant
• have problems with glucose-galactose malabsorption
• have had muscular toxicity caused by a statin or a fibrate
• have hypothyroidism, kidney problems, or liver problems
• have Lapp lactase deficiency
• are at risk of developing diabetes
• have risk factors for muscle problems

Generally, this medication is not prescribed for children under 8 years old.

To figure out whether this might be the right medication for you, the doctor may also run some tests first.

If you're taking any other medication or vitamin supplements be sure to tell the doctor when you ask for the prescription.

• Ciclosporin
• Clarithromycin
• Colestipol
• Cholestyramine
• Erythromycin
• Fenofibrate
• Gemfibrozil
• Nicotinic acid

• Bile acid sequestrants
• Fibrates
• Liver enzyme inhibitors

The most common side effects for Lipostat are experienced by over 1% of people who take it. They include abnormal laboratory test results, or muscle problems – these can also be fatal. See a doctor straight away if you get unexplained muscle pain, cramps, weakness or tenderness.

• constipation
• diarrhoea
• difficulty sleeping
• eye or eyesight problems including blurred or double vision
• dizziness
• flatulence
• headaches
• heartburn
• indigestion
• itching
• nausea and vomiting
• scalp or hair problems including hair loss
• sexual dysfunction
• skin rash or rashes
• sleeping problems
• stomach pain or ache
• fatigue
• urinary problems, including difficult or painful urination, urinating more often or urinating more often at night
• urticaria

You need to speak to your doctor about extra precautions taking Pravastatin (brand name Lipostat), because it may not be suitable for you, if you:

• are an older person
• are allergic or react badly to any of the ingredients in the medicine
• are breast-feeding
• are pregnant
• drink a lot of alcohol
• have kidney problems, or liver problems
• have risk factors for muscle problems
• are taking any other medication or vitamin supplements, be sure to tell the doctor when you ask for the prescription.

These medicines, among others, can interact with Lescol:

• Colchicine
• Cyclosporine
• Phenytoin

• memory problems or confusion
• dizziness
• headaches
• indigestion
• itching, skin rash or rashes
• nausea and vomiting
• fatigue
• urinary problems, including urinating less often or not at all, painful urination, dark urine, swelling of your ankles, feeling tired or short of breath. These could all be signs of a serious kidney problem. See a doctor straight away if you get any of these symptoms as kidney problems can be fatal
• Pain in your upper stomach, loss of appetite, tiredness, dark coloured urine, clay-coloured (pale) stools, or jaundice (yellowing of the skin or eyes), could all be signs of a serious liver problem. Seek immediate medical advice if you develop any of these symptoms as liver problems can be fatal
• muscle problems – these can also be fatal. See a doctor straight away if you get unexplained muscle pain, cramps, weakness or tenderness