FEMALE PATIENTS

What is high cholesterol?
Statins are used to control high colesterol. 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 are known as lipoproteins.

There are two types of lipoprotein:
High-density Lipoprotein (HDL) or good cholesterol: HDL returns cholesterol away from the cells back to the liver. Once it arrives there, it is 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 is an excess of 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.

What are statins?
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.

How do I take statins?
Most statins come as tablets. It is 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 aren’t sure, reread the patient information leaflet or check with your doctor or pharmacist.

Which statins are best?
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.

Statins and grapefruit - do they interact?
Drinking a glass of grapefruit juice or eating a grapefruit while taking certain types of statins can be very dangerous. Grapefruit contains the compound Bergamottin. Bergamottin interacts with several enzymes that break down statins and other medications. This means your body won’t be able to break down the medication. As a result, you may you end up with a high concentration of the drug in your body. This is dangerous and can cause liver, kidney or severe muscle damage. Always read the patient information leaflet for more information, or ask your doctor if you are worried.

Can I take statins and alcohol at the same time?
Alcohol and statins can both damage your liver. You should not drink excessively while taking statins and discuss any regular alcohol consumption with a doctor, to make sure you are not causing any damage to your liver. When starting treatment with statins, please read the patient leaflet for detailed information about your statin and alcohol.

How can I tell whether my cholesterol is too high?
Cholesterol can be measured with a blood test – either blood is taken with a syringe or by pricking your finger. There isn’t a set level of cholesterol that is recommended, because it varies depending on whether you are healthy or at a high risk of heart disease.

Which risk factors are there?
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 under-active 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

• 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. 

Which treatment options are there?
The first thing you should do to lower high cholesterol is to increase the amount of exercise you are doing and eat more healthily. If this doesn’t work, then your doctor will probably suggest trying medication.

How different statins compare?
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.

Is there a price difference?
Simvastatin and pravastatin are made by generic manufacturers and so are now significantly cheaper than other brands of statins.

What are triglycerides?
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.

What should I do first?
The first thing you should do to lower high cholesterol is increase the amount of exercise you are doing and eat more healthily. If this doesn’t work, then your doctor will suggest trying medication.

How should I adjust my lifestyle?
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 are 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 and 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.

Are there alternatives to statins?
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.

What is Niacin?
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 isn’t used very often.

What is Ezetimibe?
Ezetimibe is medication that stops your body absorbing cholesterol and bile juices from the intestines into your blood. It is generally not as effective as statins, but it rarely has side effects and therefore 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 want to try this.

List of statins
There are many different types of statins. The five types available in Ireland 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.

Which treatment is right for me?
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.

Side Effects of Statins
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 are able to spot any side effects and are aware of any warnings and risks.

Simvastatin (brand name Zocor)
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 got 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.

Which medicines can interact with Zocor?
Be sure to tell your doctor if you are taking vitamin supplements or any of these drugs:

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

These types of medicine can also interact with Zocor:

• Anticoagulants

• calcium channel blockers

• cytochrome P450 enzyme inducers

• cytochrome P450 enzyme inhibitors

• fibrates

• HIV protease inhibitors

Which side-effects can occur?
Side effects are rare. However, they include: abnormal laboratory test results, blood problems, constipation, diarrhoea, feeling dizzy, flatulence, hair loss, headaches, indigestion, itching, nausea, neuropathy of the extremities, pancreatitis, paraesthesiae, rhabdomyolysis , skin rash or rashes, stomach pain, vomiting, weakness, liver problems (These can be fatal. Seek immediate medical advice if you develop jaundice.), muscle problems (These can also be fatal. See a doctor straight away if you get unexplained muscle pain, cramps, weakness or tenderness.)

Atorvastatin (brand name Lipitor)
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

• 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

Your body’s reaction to Lipitor can change with time. If this happens, contact your doctor straight away. If you are taking any other medication or vitamin supplements be sure to tell the doctor when you ask for the prescription.

Which medicines can interact with Lipitor?
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

These types of medicines can also interact with Lipitor:

• 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

What do I need to know about side-effects?
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. They can be fatal. Always read the patient information leaflet so that you are also informed of the less common side effects.

Rosuvastatin (brand name Crestor)
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:

• 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 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
  

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

These medicines can interact with Crestor:
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

These types of medicines can also interact with Crestor:

• aluminium / magnesium antacids

• azole antifungal agents

• coumarin anticoagulants

• fibrates

• hormone replacement therapy

• lipid lowering agents

• macrolides

• oral contraceptives

• protease inhibitors

• vitamin K antagonists

The most common side effects for Crestor are:

• 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

Pravastatin (brand name Lipostat)
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

• 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 of age. To figure out whether this might be the right medication for you, the doctor may also run some tests first. If you are taking any other medication or vitamin supplements be sure to tell the doctor when you ask for the prescription.

These medicines can interact with Lipostat:
Ciclosporin, clarithromycin, cholestipol, cholestyramine, erythromycin, fenofibrate, gemfibrozil, nicotinic acid

These types of medicines can also interact with Lipostat:

• bile acid sequestrants

• fibrates

• liver enzyme inhibitors

What are the side-effects of Lipostat?
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.

Less common side effects include:

• 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

Fluvastatin (brand name Lescol)
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

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

Drug interactions:
These medicines, amongst others, can interact with Lescol: colchicine, cyclosporine, phenytoin.

Common side effects include:

• Memory problems or confusion

• dizziness

• headaches

• indigestion

• itching, skin rash or rashes

• nausea and vomiting

• fatigue

• urinary problems, including urinating more often liver problems – these can be fatal. Seek immediate medical advice if you develop jaundice

• muscle problems

• • these can also be fatal. See a doctor straight away if you get unexplained muscle pain, cramps, weakness or tenderness.

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.