How do statins help reduce low-density lipoprotein (LDL) cholesterol?

Statins work by inhibiting an enzyme called HMG-CoA reductase, which controls the body's cholesterol production rate. They ramp down production of cholesterol and boost the liver's ability to remove low-density lipoprotein (LDL) cholesterol from the blood. In several large clinical trials, they have proven their merit not only in lowering cholesterol levels, but also in achieving the ultimate goal: reducing heart attacks and deaths related to heart disease.

Most statins are usually taken once a day in the evening or before bed. The timing is important, since the body makes more cholesterol at night than during the day. It takes about four to six weeks to achieve the full effect. After six to eight weeks, your healthcare professional will probably check your LDL cholesterol and perhaps adjust your medication.

Dr. John La Puma

Nearly all people with high LDL (lousy) cholesterol and low HDL (healthy) cholesterol can change them with what they eat: the foods are well known and do not have to taste like cardboard.  I shop for them with a reporter in the expert interview below.

Statins do have a role: if you have had a heart attack and have heart disease, they reduce mortality from heart disease. But if you are simply trying to avoid taking medication and want to give food a shot, it's your best medicine.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The class of drugs called statins can help lower blood levels of LDL, or bad cholesterol, by blocking the chemical reaction in the liver that leads to production of LDL from dietary fats. Watch this animation to learn more about statins and cholesterol.

Dr. John M. Kennedy, MD
Cardiologist (Heart Specialist)

In some cases, reducing cholesterol may require taking a statin drug. In this video, preventive cardiologist John M. Kennedy, MD, discusses his recommendations for lowering cholesterol. 

Statins mostly lower the LDL-C or bad cholesterol, but also have modest effects on raising HDL-C (good cholesterol) and decreasing triglycerides. The mechanism of action of statins is complicated. They block an enzyme known as HMG-CoA reductase. This leads to multiple changes within liver and other cells that cause a decrease in production of LDL cholesterol and an increase in LDL clearance from the blood. Much of this effect is due to an increase in the expression of LDL receptors on liver and other cells that help clear it from the blood stream.  

Statins are among the most common medications used to treat patients with high cholesterol levels. Statins are generally safe and well tolerated and most patients experience very few side effects. Sometimes the medication may cause muscle aches or weakness, but those go away once the medication is stopped.

Dr. Ozgen Dogan
Cardiologist (Heart Specialist)

Statins block an enzyme in the liver that the body needs to make cholesterol. Cholesterol production decreases and, at the same time, the liver collects more low-density lipoprotein (LDL) from the blood and destroys it.

There are currently five statin drugs on the market in the United States: lovastatin, simvastatin, pravastatin, fluvastatin and atorvastatin. The major effect of the statins is to lower LDL-cholesterol levels, and they lower LDL-cholesterol more than other types of drugs. Statins inhibit an enzyme, HMG- CoA reductase that controls the rate of cholesterol production in the body. This drug lowers cholesterol by slowing down the production of cholesterol and by increasing the liver's ability to remove the LDL-cholesterol already in the blood. The large reductions in total and LDL-cholesterol produced by these drugs resulted in large reductions in heart attacks and heart disease deaths. Thanks to their track record in these studies and their ability to lower LDL-cholesterol, statins have become the drugs most often prescribed when a person with heart disease needs a cholesterol- lowering medicine.

Studies using statins have reported 20 to 60 percent lower LDL-cholesterol levels in patients on these drugs. Statins also reduce elevated triglyceride levels and produce a modest increase in HDL-cholesterol.

The statins are usually given in a single dose at the evening meal or at bedtime. It is important that these medications be given in the evening to take advantage of the fact that the body makes more cholesterol at night than during the day.

You should begin to see results from the statins after several weeks, with a maximum effect in 4 to 6 weeks. After about 6 to 8 weeks, your doctor can do the first check of your LDL-cholesterol while on the medication. A second measurement of your LDL-cholesterol level will have to be averaged with the first for your doctor to decide whether your dose of medicine should be changed to help you meet your goal.

This answer is based on source information from National Heart, Lung and Blood Institute.

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