Drinking too much can undo the cholesterol-lowering benefits of statins. Photo / 123RF
They are one of the most widely prescribed medications in the UK, but what actually happens if you mix them with your favourite drinks?
As we reach a certain age, many of us begin reaching for our pill bottles, as well as a nice glass of red.
Statins, the cholesterol-lowering drugs (which are prescribed to reduce risk of cardiovascular diseases and prevent further damage for people who have already had a heart attack) are widely taken so it‘s inevitable that some will want to keep enjoying the odd drink while taking their medications (although perhaps not simultaneously).
But can statins and alcohol really be combined? Are some worse than others? Or are they quite simply, a marriage made in hell?
Dr Raul Santos, a Brazilian cardiologist who serves as editor-in-chief for the World Heart Federation’s Global Heart Journal, is keen to emphasise that statins are, overall, extremely safe medications. “They’ve been used by millions of people for decades to reduce cholesterol, and prevent myocardial infarctions [the medical term for heart attacks] and stroke,” says Santos.
However, people can sometimes run into issues when combining them with alcohol, because the way in which statins lower LDL or “bad” cholesterol is through acting on a series of biological pathways in the liver.
In particular, statins inhibit an enzyme which actively decreases the continuing production of cholesterol, as well as enhancing the uptake and breakdown of existing LDL cholesterol in the blood.
The problem, as pointed out by Dr Oliver Guttmann, a consultant cardiologist at St Bartholomew‘s Hospital in London, is that alcohol also acts on various enzymes in the liver. “They’re both going down the same waterway, so to speak,” says Guttmann. “So the main concern is that there’s going to be some kind of congestion.”
With statins altering the liver‘s natural function, and alcohol needing to be metabolised, Guttmann says that having too much booze in your system risks impeding the liver‘s ability to carry out its vital functions such as breaking down and detoxifying toxins.
“When statins and alcohol are combined at a high level, there’s an increased risk of liver inflammation or damage,” he adds.
It‘s also not great news for those who are taking statins for the long term.
Some research indicates that excessive alcohol might impair the long-term health benefits of taking statins. As well as reducing LDL cholesterol, these drugs also improve cardiovascular health by lowering the amounts of another subtype of fat in the blood called triglycerides. But because alcohol is surprisingly calorific, consuming too much of it can send triglycerides straight back up again.
“The whole point of taking statins is to lower cholesterol and triglycerides and decrease the furring up the blood vessels in the body, especially the coronary arteries around the heart, and in the neck leading up to the brain,” explains Dr Guttmann. “But alcohol, if not taken in moderation, can actively increase the formation of plaques and high concentrations of it can cause narrowing of blood vessels. So through too much alcohol, you’re driving the things you’re trying to prevent.”
According to Guttmann, people taking statins with underlying liver problems such as fatty liver disease or hepatitis, are more likely to be at risk of developing issues through consuming too much alcohol.
Certain statins may also carry a higher risk of adverse effects. Dr Roy Jogiya, the chief medical adviser at Heart Research UK and a consultant cardiologist at Kingston and St Thomas Hospital NHS Foundation Trust, says side effects are more likely with simvastatin and atorvastatin in particular, such as fatigue or gastrointestinal issues.
“These statins are processed by a liver enzyme (called CYP3A4) which can also be affected by alcohol,” says Jogiya. “This means there may be a slightly higher risk of liver-related side effects in the context of heavy drinking. That said, for most people drinking in moderation, the difference is unlikely to be clinically significant, but we take these factors into account when prescribing.”
The risk of worsening muscle aches and pains has sometimes been described as one of the main factors which puts people off taking statins, and according to cardiologists, there is a chance that alcohol may exacerbate this.
One of the reasons for this is that excess alcohol can not only drive muscle inflammation but disable certain liver enzymes which break down and clear statins from the body, meaning that the liver is being exposed to higher levels of the drugs. “It‘s as if you’re taking a higher dose of the statin,” says Guttmann.
Santos agrees that this is a possibility. “Alcohol can cause or exacerbate muscle pains and digestive issues in people taking statins, and one should be aware of that,” he warns. “The right thing to do is stop or reduce drinking, rather than stopping statins or other cholesterol-lowering medications.”
At the same time, Santos points out that while muscle aches are typically attributed to statins, clinical trials suggest that pains directly caused by a statin are quite rare, only occurring in 1-3% of users.
“Muscle aches are sometimes reported by people on statins, but in many cases, they’re caused by other factors, not the statin itself,” says Jogiya. “That said, alcohol can contribute to dehydration and may affect muscle function, which could make symptoms more noticeable.”
One of the most serious statin concerns is a very rare side effect called rhabdomyolysis, or the complete breakdown of muscle cells, which occurs in 0.01% of users. Guttmann says that too much alcohol could also exacerbate this effect, but the overall chances of this happening are still very unlikely.
Guttmann says that if anyone is particularly concerned about statin-alcohol interactions, he would recommend taking either newer forms of the drugs such as pravastatin or rosuvastatin. “While they’re metabolised by the liver as well, it‘s not by the same enzymes, and therefore, there’s a lower risk of liver-related effects,” he explains.
So how much alcohol should you stick to? Santos suggests that all statin users should aim to stay within the guidelines of seven units per week for women and 14 units for men, while Guttmann says that drinking advice should take into account whether the patient has any other underlying liver conditions.
“It depends on other conditions: does the patient have fatty liver, or cirrhosis which is a very significant liver problem?” he says. “Do they have hepatitis or any underlying muscle or kidney problems? Do they take any other medications, as lots of drugs also work on the liver, and sometimes a combination of things can be quite toxic. So all of this needs to be discussed with their doctor.”
But overall, if a patient really wants to have the option to continue drinking alongside statins, Guttmann says that the equivalent of one standard glass of wine per day is what he suggests as a general rule.
“This is usually what I would recommend,” he says. “And you shouldn’t drink every day, maybe have some gaps, but that should be OK.”
Jogiya says: “In short – yes, but with care. Moderate alcohol consumption is unlikely to cause issues for most people taking statins, but it‘s important to look at the bigger picture.
“Statins are prescribed to protect long-term heart health, and drinking habits should ideally align with that goal. Occasional, moderate drinking, particularly when enjoyed with food and within recommended weekly limits, can usually be managed safely. I’d always recommend discussing it with a GP or pharmacist, especially if there are any concerns about side effects or liver function.”
Guttmann adds: “Generally, if you have a little bit of alcohol, no more than a glass of wine a day, it‘s generally safe. I don’t really come across people who have been advised not to have any alcohol at all with statins. But the bottom line is that moderation is really important. Heavy or chronic drinking will significantly increase your risk of statin-related problems.”
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