Statins: Are these cholesterol-lowering drugs right for you?
Find out whether your risk factors for heart disease make you a good candidate for statin therapy.
By Mayo Clinic Staff
Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks.
Statins include medications such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Lower-cost generic versions of many statin medications are available.
Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What kinds of side effects may occur? Can statins help prevent other diseases?
Should you be on a statin?
Whether you need to be on a statin depends on your cholesterol level, along with your other risk factors for cardiovascular disease.
Most people should try to keep their total cholesterol level below 200 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L). Low-density lipoprotein cholesterol (LDL, or "bad" cholesterol) should be below 100 mg/dL (3.37 mmol/L).
But the numbers alone won't tell you or your doctor the whole story. High cholesterol is only one of a number of risk factors for heart attack and stroke.
The most important factor to consider is a person's long-term risk of experiencing a heart attack or stroke. If the risk is very low, there is probably no need for statins, unless the LDL is above 190 mg/dL (4.9 mmol/L). If the risk is very high — for example, someone who has had a heart attack in the past — the person may benefit from statins, even if his or her cholesterol is not elevated.
Risk assessment tools
Your doctor may suggest using an online tool to better understand your long-term risks of developing heart disease.
The American College of Cardiology and the American Heart Association have recently developed an online tool to predict a person's chances of having a heart attack in the next 10 years. For people under the age of 50, the Framingham cardiovascular disease risk calculator might be a better option because it provides a 30-year risk prediction.
In addition to your cholesterol numbers, these risk calculators also ask about your age, race, sex, blood pressure and whether you have diabetes or smoke cigarettes.
New cholesterol guidelines
New guidelines from the American College of Cardiology and American Heart Association focus on four main groups of people who may be helped by statins:
- People who already have cardiovascular disease. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, mini-strokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.
- People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher.
- People who have diabetes. This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease.
- People who have a higher 10-year risk of heart attack. This group includes people who have an LDL above 100 mg/dL (1.8 mmol/L) and whose 10-year risk of a heart attack is 7.5 percent or higher.
Lifestyle is still key for preventing heart disease
Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. To reduce your risk:
- Quit smoking and avoid secondhand smoke
- Eat a healthy diet that's low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains.
- Be physically active, sit less and exercise regularly
- Maintain a healthy waist girth: less than 40 inches in men and less than 35 inches in women
If you're following the recommended lifestyle behaviors but your cholesterol — particularly your LDL (bad) cholesterol — remains high, statins might be an option for you. Risk factors for heart disease and stroke are:
April 08, 2015
- High cholesterol
- High blood pressure
- Being overweight or obese
- Family history of heart disease, especially if it was before the age of 55 in male relatives or before 65 in female relatives
- Not exercising
- Poor stress and anger management
- Older age
- Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)
- Rosenson RS. Statins: Actions, side effects, and administration. http://www.uptodate.com/home. Accessed March 23, 2015.
- Drug therapy for cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp. Accessed March 23, 2015.
- AskMayoExpert. Hyperlipidemia: What are the newly released American College of Cardiology and American Heart Association guidelines on heart disease prevention (including new guidelines for treatment of cholesterol abnormalities) and what are Mayo's recommendations in response to these new guidelines? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Rosenson RS. Statins: Possible noncardiovascular benefits. http://www.uptodate.com/home. Accessed March 23, 2015.
- Levels of cholesterol. American Heart Association. http://www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats101/Levels-of-Cholesterol_UCM_305051_Article.jsp. Accessed March 24, 2015.
- Rosenson RS. Treatment of lipids (including hypercholesterolemia) in secondary prevention. http://www.uptodate.com/home. Accessed March 24, 2015.
- What are coronary heart disease risk factors? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hd#. Accessed March 25, 2015.
- Hennekens CH. Overview of primary prevention of coronary heart disease and stroke. http://www.uptodate.com/home. Accessed March 25, 2015.
- FDA expands advice on statin risks. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm. Accessed March 25, 2015.
- Rosenson RS, et al. Statin myopathy. http://www.uptodate.com/home. Accessed March 25, 2015.
- Opie LH. Present status of statin therapy. Trends in Cardiovascular Medicine. 2015;25:216.
- Lopez-Jimenez F (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2015.