Statins lower cholesterol for millions of people. They also can help protect you from heart attacks and strokes. But for some people who take them, they don’t work well enough.
If your statin doesn’t help, don’t worry. Your doctor can help you find other treatments. But first, they’ll give you a few tests to see why the statin didn’t work and how much extra help you need. Then, you and your doctor will talk about all of your risk factors and your preferences to come up with your new treatment plan.
One of the first things your doctor will do is talk with you more about your family history. You can tell them more about any heart problems that your parents or siblings have had in the past. If your father or a brother had a heart attack before age 55, or if your mother or a sister had a heart attack before age 65, your chances of heart disease are higher.
If your family history puts you at higher risk, your doctor may decide to prescribe either a higher dose of your statin or add another cholesterol drug.
Blood tests can give your doctor a better idea of why your statins aren’t working well, or why you have side effects from them.
Muscle pain or dark urine are signals that your medication might be damaging your muscles. If that’s the case, one type of blood test will show that you have a higher amount of a substance called creatine kinase (CK).
Your doctor may also check your amount of “bad” LDL cholesterol to see if the statins aren’t working. They may ask about your diet and whether you drink alcohol to see if they’re boosting your LDL cholesterol.
Inflammation may be linked to high cholesterol. Your doctor can look for subtle signs of it in your blood, including one called the high-sensitivity C-reactive protein (hs-CRP). If your hs-CRP levels are 2 mg/L or higher, your doctor may prescribe a higher dose of your statin or another drug.
Your doctor may test your thyroid gland, too. If it’s not making enough hormones, a condition called hypothyroidism, it may cause muscle pain when you take statins.
Checking Your Heart Risk
A high cholesterol level is one of the main things that can lead to heart attacks and strokes. When your doctor is thinking about how to bring your levels down, they might use a few different tests to check how high your risk is for these problems. That will help them decide what changes to make to your treatment plan.
Carotid ultrasound. Two of the major blood vessels in your neck are your carotid arteries. When they have thick, fatty deposits of cholesterol inside, it’s a sign you’re at higher risk for a heart attack or stroke. Your doctor might do an ultrasound scan of your neck called a carotid intima-media thickness test to check them out.
Coronary calcium scan. This CT scan of your chest can help doctors spot calcium buildup in the arteries around your heart, a sign that they have too much plaque.
Ankle brachial index test. High blood pressure is a major sign of heart disease risk. This test measures the blood pressure in your legs. Your doctor will put a blood pressure cuff around your ankles as you lie on a table. It helps your doctor compare your blood pressure in both your legs and your arms. Your total score is the division of your ankle blood pressure reading by your arm blood pressure reading. Scores above 1.4 may mean you have calcium buildup in your blood vessels. Scores below 0.9 are a sign of peripheral artery disease (PAD).
Some people have very high cholesterol because of a problem with one of their genes. This condition is called familial hypercholesterolemia or FH. If you have it, statins may not be able to lower your levels enough. You may need stronger treatment or, in some cases, a liver transplant.
A blood test can offer other clues. If your total cholesterol levels are above 300 mg/dL, or if your LDL is above 200 mg/dL, your doctor may run tests to see if you have FH. Your doctor might also study how well your heart works while you walk on a treadmill, called a stress test.
What Happens Next
If your treatment plan doesn’t reduce your cholesterol enough, your doctor might:
- Change your medication dosage
- Try a stronger statin
- Add or switch to another type of cholesterol drug
- Suggest changes to your lifestyle, such as diet or exercise