Last Updated: January 03, 2025
Medically reviewed by NKF Patient Education Team
About statins
Statins are a type of oral (taken by mouth) prescription medicine commonly recommended for many people living with chronic kidney disease (CKD). CKD increases your risk of heart attack and stroke, also known as cardiovascular disease (CVD). Your risk is even higher if you also have albuminuria (protein in your urine). So, it is important to take steps to lower your risk. In addition to healthy eating and physical activity, statins are very helpful for lowering your risk of CVD.
Uses
Statins have been used in the United States since the early 1990s to help people lower LDL cholesterol levels (sometimes called “bad cholesterol”). Statins have also been shown to lower the risk of CVD (heart attack or stroke), even in people who do not have high cholesterol. For people who have already had a heart attack or stroke, statins work very well to lower the risk of having another event.
Current guidelines recommend a statin for people with CKD who are over 50 years old and not on dialysis.
For people with CKD who are between the ages of 18 and 49 and not on dialysis, the guidelines recommend a statin only if you have one or more of the following risk factors:
- Personal history of heart attack, stroke, or angina (chest pain)
- Diabetes
- Peripheral artery disease (PAD)
Other risk factors for CVD (heart attack or stroke) that may warrant taking a statin include:
- High LDL cholesterol (“bad cholesterol”) levels
- High blood pressure
- Family history of premature heart attack – this means a male relative had one when he was younger than 55 or a female relative had one when she was younger than 60
- Smoking or recent history of smoking
Statins for people on dialysis
If you are on dialysis, statin recommendations depend on your personal situation. People on dialysis are at extremely high risk for cardiovascular events (heart attack or stroke). But clinical trials with statins for people on dialysis have shown conflicting results.
If you are already on a statin when you start dialysis, it is okay to continue if you are tolerating it. Talk with your healthcare professional about the risks and benefits to you, and whether it is appropriate to continue your statin.
If you are not already on a statin when starting dialysis, the available data are not as strong, and guidelines recommend against starting one while on dialysis.
How they work
Statins work by slowing down how much LDL cholesterol (“bad cholesterol”) your liver naturally makes. They also increase your liver's ability to remove LDL cholesterol from the blood. Both help to lower your overall LDL cholesterol levels.
Statins also work in other ways, separate from lowering cholesterol, including:
- Slowing the buildup of plaque (fat deposits) and the hardening of your arteries (blood vessels)
- Reducing inflammation (leaky blood vessels) throughout your body
- Improving blood flow throughout your body
- Lowering the risk of blood clots in the blood vessels of your heart and brain
- Protecting against damage to cells in your body (also known as “antioxidant effects”)
These other effects also help lower your risk of CVD (heart attack or stroke).
Statins are very helpful for lowering your risk of CVD (in combination with healthy eating and physical activity), even if you do not have high cholesterol.
Types
There are many different options to choose from. All of them are taken once daily by mouth and most are available as low-cost generic options. Some examples include:
- atorvastatin (Lipitor, Atorvaliq)
- fluvastatin (Lescol XL)
- lovastatin (Altoprev)
- pitavastatin (Livalo, Zypitamag)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor, Flolipid)
Some statins are also available as combination products with other medications for high cholesterol or high blood pressure. These can help lower the overall number of tablets you need to take each day.
Effectiveness
All statins help lower the risk of cardiovascular disease (CVD - heart attack or stroke). But some statins are stronger than others, mainly atorvastatin and rosuvastatin. “Stronger” means that they lower LDL cholesterol (“bad cholesterol”) more than other statins. For this reason, they are usually most preferred for people who are at the highest risk for CVD, including people with CKD who are not on dialysis.
One myth about statins is they only benefit people who have high LDL cholesterol (“bad cholesterol”). This is not true. People with kidney disease who are at a high risk for heart attack or stroke can still benefit from a statin, even if you do not have high cholesterol.
Side effects
Muscle aches or soreness
This is one of the most common side effects reported by people taking statins. It can be described as cramping, tenderness, stiffness, heaviness, and/or weakness in the large muscle groups across your body (mainly in your arms and legs). Sometimes, these symptoms go away on their own, but not always. Talk with your doctor if you experience any of these symptoms. For most people, using a lower dose of the same statin or switching to a different statin helps stop these symptoms.
Nausea, diarrhea, and/or constipation
These side effects happen with many medications, not just statins. Each person responds to medications differently. If any of these side effects do appear, they are usually temporary and go away on their own over time. If that is not the case for you, talk to your healthcare professional about trying a lower dose or a different statin.
Liver damage
Rarely, statins can cause liver damage. This can be monitored with a common blood test (also known as ALT and AST levels). If liver damage is present, the results of these tests go up. If the increase is mild, it is usually okay to continue the statin. Sometimes the dose may need to be lowered.
If the increase is severe, the statin will likely need to be stopped temporarily. Once your liver tests normalize, your healthcare professional will talk with you about what to do next. The decision about trying again (with either the same statin or a different one) depends on your risk for side effects, your level of risk for heart attack or stroke, and your personal preferences.
Do not change your statin dose or stop taking your statin unless you talk with your healthcare team first.
Additional considerations
Drug interactions
Some statins can interact with other medicines, supplements, or foods. Not all interactions are high risk for safety concerns. The importance of these interactions and recommendations for managing them will depend on many factors, starting with which statin you are prescribed. So, make sure your healthcare team always has the most updated list of your medications, supplements, and herbal products.
Also, many drug interactions happen when short-term treatments are added to your regimen (like an antibiotic or antifungal). So, talk with your healthcare professional about your level of risk, especially when you start a new medication, supplement, or herbal product.
Pregnancy and breastfeeding
Statins are not recommended for most patients who are pregnant. Tell your healthcare professional right away if you are pregnant or planning to become pregnant.
Also, talk with your healthcare professional if you are breastfeeding or plan to do so. Breastfeeding is not recommended in patients taking a statin. Your healthcare professional can help advise you whether it will be better to stop the statin temporarily or whether you need to continue taking it and so should not breastfeed. If ongoing statin treatment is necessary, infant formula and other alternatives are available.
Lifestyle recommendations
Statins work best to lower your risk of heart disease and stroke when they are combined with healthy lifestyle choices. These include:
- If you smoke and/or use tobacco products, stop. Smoking can speed up the kidney disease process and increase your risk of kidney failure. It also increases your risk for other serious health problems, including high blood pressure, heart disease, cancers, and stroke.
- Limit your alcohol use. Too much alcohol can damage your liver and increase your risk of side effects from statins. Too much alcohol can also increase your risk of heart disease.
- Exercise regularly. Remember, it’s okay to start slowly – taking short walks is a great way to begin.
- Lower the amount of fat and cholesterol you get in your diet. Healthy dietary approaches like the DASH diet, Mediterranean diet, or plant-based diet can help with your overall health.
- Sleeping well is important, too. Try to get enough sleep so you are well rested.
- If you have overweight or obesity, losing weight through a balanced diet and physical activity can help improve your health in many ways.
- Find ways to reduce and manage stress in your life.
Questions for your healthcare team
- Should I be taking a statin to lower my risk of cardiovascular disease (CVD)?
- Most, but not all, people with CKD can benefit from taking a statin. So, it is important to talk with your healthcare professional about the risks and benefits of treatment for your personal situation, weighed against your risk for CVD.
- Should I be concerned about any drug interactions between my statin and any of my other medications, supplements, or foods?
- Remember, not all statins have interactions, and not all interactions are high risk for safety concerns. So, this question is important to learn if this applies to you. If there is a concern for interactions, talk about a plan for resolving it (like lowering the dose or switching to a different statin). Also, many drug interactions happen when short-term treatments are added to your regimen (like an antibiotic or antifungal). So, whenever you start a new medication, ask your pharmacist or other healthcare professional if there is a concern for interaction with your statin.
- [If having trouble tolerating your statin] I’m having trouble tolerating my statin - is it possible to try something different?
- Talk with your healthcare professional about what you are experiencing. Many symptoms are dose-dependent, meaning a higher dose comes with more side effects. So, it may be possible that a lower dose of the same statin can help. Or it may be beneficial to try another statin instead. Be patient with your healthcare team. Some people need to try 2 or 3 different statins before they find the right one!
- What else can I do to lower my risk of cardiovascular disease (CVD)?
- Remember, statins work best to lower your risk of heart disease and stroke when they are combined with healthy lifestyle choices. If this combination is not enough (or you are not able to tolerate any statins), other medications may be added to lower your risk even more – especially if you are very high risk for or already have CVD.
