By |
If you are a senior or elderly adult with high cholesterol, your doctor might recommend taking a statin. These are considered the first-line treatments against high cholesterol and have been around for many years. Most people tolerate statins just fine; however, the medications can have troubling side effects for some. For others, statins might have no side effects at all but they also don’t lower their cholesterol enough.
It makes sense why doctors reach for statins first. According to Million Hearts, a website of the CDC, statins can protect you from a host of problems. Statins can greatly reduce your chances of a heart attack or stroke, help you avoid surgeries or procedures like angioplasty or stents, and lower your risk of dying from a cardiovascular event. The longer you take a statin, the more of a benefit it seems to have. In fact, those who are on statins long-term can reduce their risk of heart attack by 50%.1
But what if you can’t tolerate statins? Fortunately, there are other medications and treatments that can lower your cholesterol levels. We’ll take a look at the alternatives, but first, we’ll explore why statins can be problematic.
Why Do Some Seniors Not Tolerate Statins?
Though most of the cholesterol in your body comes from food – which is why doctors always recommend a healthy diet to lower cholesterol – some of the cholesterol is produced by the liver. Statins work by reducing the amount of cholesterol the liver produces, helping the liver remove the cholesterol in your blood, and reducing inflammation in the walls of your arteries.
Statins are helpful for many seniors. But for at least one in four individuals, statins lead to troubling side effects. The most common side effects reported are muscle aches and weakness. Your doctor might choose to switch to a different statin, which often does the trick. But some find that no matter which statin they are on, they suffer from muscle aches and weakness that can affect their day-to-day life.
And in some severe cases, muscle damage can occur. This is known as rhabdomyolysis. According to GoodRx, this condition occurs when the muscle tissue breaks down and the toxins created seep into the bloodstream.2
This same condition can occur if you suffer a fall and wind up lying on the floor for a long time while you wait for help; that’s why a fall alert for seniors and elderly adults is so important as a life-saving tool. Those who are on statins should have medical alert technology at their fingertips.
For seniors who suffer from side effects when they take statins, there are alternatives to discuss with your doctor.
Options Other Than Statins
Many believe that the only option other than statins is a very strict low-cholesterol diet. And while that might work for some, remember that because cholesterol is made in the liver, sometimes even the best possible diet won’t be enough to lower cholesterol to a safe level for some people.
The medications that work for you will depend upon many factors, including your age, any chronic conditions, whether you have had a stroke or heart attack in the past, how high your cholesterol and triglyceride levels are, and if you are a smoker. Your doctor will also look for a medication that is covered by your insurance company and otherwise fits your budget.
Remember, when you are changing medications, your body needs time to adjust. You might experience side effects during the initial weeks of starting or stopping a medication, such as dizziness, weakness, headaches, stomach upset, and more.
Since you never know how your body will react, it’s a great idea to have an emergency alert system on your person at all times. If your body doesn’t react well to the change and you suffer a fall or medical emergency, the button alert can ensure that help is secured immediately, around the clock, no matter what.
Fibrates
This class of medications includes fenofibrate and gemfibrozil. While these medications lower cholesterol by about 15-20%, what they really do well is lower your triglyceride levels. If your cholesterol is slightly elevated but your triglyceride levels are very high, it would make sense to take a fibrate.
Some doctors will try to combine a statin with a fibrate. But if you have side effects from statins, the effect is increased by the fibrate. Therefore, it’s usually not recommended to take a fibrate along with a statin.
Bile Acid-Binding Resins
Also known as “bile acid sequestrants,” these include medications like cholestyramine, colestipol, and colesevelam. They work by attaching to the bile acids in the liver; those bile acids are what the body uses to absorb and digest fats. The medication then eliminates the bile acids through the stool. Because the body can’t fully digest the fats in food, the result is a lowering of cholesterol levels (assuming you are combining these medications with a healthy diet).
These were quite common before statins came along. But they have some troublesome side effects, including constipation or stomach upset, and might cause nutritional deficiencies with long-term use.
PCSK9 Inhibitors
This is a newer alternative to statins. The most common include alirocumab and evolocumab. These are injected once a month and work by blocking the PCSK9 enzyme in the liver. This enzyme usually stops the body from breaking down the “bad” cholesterol; when it is blocked, the body breaks down the cholesterol and thus gets rid of it more easily, resulting in lower cholesterol levels. A doctor will usually consider this drug after you’ve tried statins.
These inhibitors have been proven to be very effective; however, they are also very new. That means that there aren’t any long-term studies on what they do to the body. They also have the side effect of flu-like symptoms in the days or even weeks following the injection, which might make it a no-go for some.
What if You Can Tolerate Statins But They Aren’t Enough?
Some people don’t have issues with side effects of statins but find that the drugs don’t do enough to lower their cholesterol to a safer level. In that case, there are medications that can be combined with the statins to help lower those levels.
Ezetimibe
If you can tolerate statins but they don’t do enough to bring your cholesterol levels down, this medication can help as an addition to the statin. It works by blocking your small intestine from absorbing cholesterol from the food, forcing your body to use the cholesterol in your blood; that lowers the levels of “bad” cholesterol.
This one is so popular that it’s often prescribed as a combination pill called Vytorin, which contains both the statin and the ezetimibe. It has a low risk of side effects but is really only good for those who are already on statins and can tolerate them well, as it doesn’t lower cholesterol much on its own.
Inclisiran
This is another PCSK9 blocker, but it works by turning off the gene that makes the enzyme instead of blocking the enzyme itself. It helps lower LDL cholesterol and is recommended for those who have serious health conditions in addition to high cholesterol. It’s a twice-yearly injection that when combined with a statin can lower cholesterol levels by up to 50%. There appear to be few side effects beyond pain or swelling at the injection site.
ACL Inhibitors
These medications are newer options that work by blocking the ACL enzyme, which helps your liver make cholesterol. Sold as bempedoic acid or as a combination of bempedoic acid and ezetimibe, it is an alternative to statins.
Other Alternatives to Statins
There are other, more natural alternatives to statins and other cholesterol-lowering medications. Before taking any of these, talk with your doctor about whether it’s a good idea for you and your particular health situation.
· Niacin. Some studies have found that vitamin B3 reduces bad cholesterol and raises the good cholesterol, but those studies also found little evidence that it actually reduces the risk of heart attack or stroke. Be aware that niacin can cause intense skin flushing, which might be uncomfortable.
· Fish oil. The power of omega-3 in the body has been well-documented, including its ability to lower triglycerides. For some, however, it might actually increase cholesterol levels. That’s why it’s very important to talk to your doctor before you start taking fish oil, as your cholesterol levels need close monitoring to ensure this option is right for you.
· Plant stanols and sterols. You can find these ingredients in certain drinks, including those made with yogurt. While there is some evidence that cholesterol can drop by up to 12% while adding these to a healthy diet, the jury is still out on whether they reduce the risk of heart attack or stroke.
· Red yeast rice extract. This is sold as an over-the-counter supplement and might lower your cholesterol levels by up to 25%; it seems to work the same way in the body as a low-dose statin. However, since it is a supplement and thus not heavily regulated the way that prescription drugs are, you might not get a consistent dose.
The Importance of a Healthy Diet
No matter what medication your doctor prescribes, they will strongly recommend following a healthy diet that takes cholesterol into account. While you can’t control how much cholesterol your liver produces, you can certainly control how much cholesterol you put into your body!
Here are the good rules of thumb for a low-cholesterol diet, according to Harvard Health:3
· Try to eliminate trans fats and limit saturated fats in your diet. If you see “partially hydrogenated” on the packaging of any food, it has trans fats – stay away! Saturated fats are found in things like eggs, red meat, butter, and organ meats; it’s good to have these occasionally, but only in small portions now and then.
· Make a point of using polyunsaturated and monounsaturated fats. These include oils like canola, olive, grapeseed, and sunflower, as well as foods like seeds, nuts, avocados, and fatty fish.
· Fill your plate with color! Fruits and vegetables that have a richer hue are usually better for you. So go for that bright yellow squash, those vibrant peppers, carrots, tomatoes, plums, strawberries, and more.
· Choose whole-wheat flour, brown or wild rice, and old-fashioned oatmeal. These are excellent alternatives to refined flour and sugars. When purchasing foods, look at the label – if you notice sugar, corn syrup, or anything ending in “ose” at the top of the ingredients list, look for something else.
As you embark on the journey to lower cholesterol and get healthier, Alert1 can be your constant companion. Using in-home or mobile medical alert systems for seniors with GPS is an excellent idea as you work to lower your cholesterol levels and try out different medications or lifestyle changes that can help you get there. If you begin to feel any adverse side effects of medications, suffer a medical emergency, or simply feel muscle weakness as your body adjusts, press the medical alert button to get whatever help you need, whenever you need it.