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Should I take Crestor or Lipitor, with niacin, to lower my cholesterol?

Consumer Reports News: October 19, 2012 04:53 PM

A: No. The combination can be risky. Some doctors will prescribe high doses of niacin to help reduce LDL (bad) cholesterol levels, increase HDL (good) cholesterol, or decrease elevated triglycerides, when a statin alone has not been enough. But the combination of the two might increase the risk of muscle pain that can be debilitating, and a rare, life-threatening form of muscle breakdown called rhabdomyolysis that can lead to permanent kidney damage and coma. There's also no clear evidence that statin drugs and niacin together work any better than a statin alone, according to an analysis by the Agency for Healthcare Research and Quality.

Statins by themselves can cause the same muscle problems, especially when taken at high doses. But that risk, for some people, is worth taking, because statins have been proven to help lower cholesterol levels and to reduce the risk of heart attack and stroke in appropriate patients. Unfortunately, they can also increase the risk of other serious side effects, such as type 2 diabetes. As with all medications, the benefits must outweigh the risks.

"When the benefits of a medication are unproven or questionable, any risk, no matter how uncommon, is unacceptable," says Marvin Lipman, M.D., Consumer Reports chief medical adviser.

Many people with high cholesterol might be able to reduce it to healthy levels by getting regular exercise, modifying their diet, losing weight and making other lifestyle changes, without the need for medication. If you already take a statin, those changes might allow you to stop your medication or reduce the dose, which can in turn lower your risk of side effects. However, a statin can be appropriate if you have very high LDL levels or other heart-attack risk factors, such as obesity, smoking, diabetes, high blood pressure, or a family history of heart disease.

To learn more about statins, check out our free Best Buy Drugs report on these medications. Also, read about ways you can reduce your cholesterol without medication.

Steve Mitchell


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