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.
Several statins are available for use in the United States. They include:
- atorvastatin (Lipitor)
- lovastatin (Altoprev)
- pitavastatin (Livalo)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor)
Sometimes, a statin is combined with another heart health medication. Examples are atorvastatin/amlodipine (Caduet) and simvastatin/ezetimibe (Vytorin).
Increasing evidence suggests that statins do more than just lower bad cholesterol. Research has found that the medicines can safely prevent heart disease in certain adults ages 40 to 75. But the benefits aren't entirely clear for the elderly. And doctors still want to know more about the side effects of statins.
Should you be on a statin?
Whether you need to be on a statin depends on your cholesterol levels and other risk factors for cardiovascular disease. Your doctor will consider all of your risk factors for heart attacks and strokes before prescribing a statin.
But knowing your cholesterol numbers is a good place to start.
- Total cholesterol. Most people should try to keep their total cholesterol below 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L).
- Low-density lipoprotein cholesterol (LDL). The ideal level for this "bad" cholesterol is under 130 mg/dL, or 3.4 mmol/L. If you've had a heart attack, aim to keep it below 100 mg/dL, or 2.6 mmol/L. If you're at very high risk of a heart attack or stroke, you may need to aim even lower (below 70 mg/dL, or 1.8 mmol/L.
The most important thing that your doctor will keep in mind when considering statin treatment is your long-term risk of experiencing a heart attack or stroke. If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.9 mmol/L).
If your risk is very high — for example, you've had a heart attack in the past — a statin may be helpful even if you don't have high cholesterol. However, everyone is different. Talk to your doctor about your specific risks and benefits.
Risk assessment tools
Your doctor may use an online tool or calculator to better understand your long-term risks of developing heart disease and whether a statin may be right for you.
Depending on the tool used, your doctor may be able to predict your chances of having a heart attack in the next 10 to 30 years. The tool may consider your cholesterol levels as well as your age, race, sex, blood pressure, smoking habits and history of diabetes.
Not everyone with a heart condition needs to use a statin. Guidelines from the U.S. Preventive Services Task Force, American College of Cardiology and American Heart Association outline four main groups of people who may be helped by statins:
- People without cardiovascular disease who have risk factors for the disease and a higher 10-year risk of a heart attack. This group includes people who have diabetes, high cholesterol, high blood pressure, or who smoke and whose 10-year risk of a heart attack is 7.5 percent or higher.
- People who already have cardiovascular disease related to hardening of the arteries (atherosclerosis). This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, ministrokes (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 or other risk factors for heart disease such as high blood pressure, smoking or being older than age 40.
The U.S. Preventive Services Task Force recommends starting low- to moderate-dose statins in adults ages 40 to 75 who have one or more risk factors for cardiovascular disease (CVD) and at least a 1 in 10 chance of having a CVD event in the next 10 years.
Healthy lifestyle is still key for preventing heart disease
Risk factors for heart disease and stroke are:
- 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)
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 waistline: less than 40 inches in men and less than 35 inches in women.
If your cholesterol — particularly the LDL (bad) type — remains high after you make healthy lifestyle changes, statins might be an option for you.
Consider statins a lifelong commitment
You may think that once your cholesterol goes down, you can stop taking statin medication. But if the drug helped lower your cholesterol, you'll likely need to stay on it for the long term. If you stop taking it, your cholesterol levels will probably go back up.
There is one exception: If you make significant changes to your diet or lose a lot of weight, you may be able to lower and control your cholesterol without medication. However, don't make any changes to your medications without talking to your doctor first.
The side effects of statins
Statins are well-tolerated by most people, but they do have side effects. Some side effects go away as the body adjusts to the medication. But always tell your doctor about any unusual signs or symptoms you might have after starting statin therapy. Your doctor may want to decrease your dose or try a different statin. Never stop taking a statin without talking to your doctor first.
Commonly reported side effects of statins include:
- Muscle and joint aches
However, several research studies comparing statins versus a placebo (fake pill) have found a very small difference in the number of people reporting muscle aches. About 1 in 20 people (5 percent) have muscle aches when using very high doses of statins.
Rarely, statins can cause more-serious side effects such as:
- Increased blood sugar or type 2 diabetes. It's possible that your blood sugar (blood glucose) level may slightly increase when you take a statin, which can lead to type 2 diabetes. This is especially likely if your blood sugar is already high. However, the benefit of taking a statin may potentially outweigh the risk. Studies show that those with diabetes who take statins have much lower risks of heart attacks.
- Muscle cell damage. Very rarely, high-dose statin use can cause muscle cells to break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. This can lead to severe muscle pain and kidney damage.
- Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is mild, you can continue to take the drug. Low to moderate doses of statins do not appear to severely raise liver enzyme levels. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.
- Cognitive problems. Some people have reported memory loss and confusion after using statins. However, the U.S. Preventive Services Task Force has not found any evidence to prove that statins actually cause cognitive problems.
Also, ask your doctor if the statin you use will interact with any other prescription or over-the-counter drugs or supplements you take.
What other benefits do statins have?
Statins may have benefits other than just lowering your cholesterol. One promising benefit seems to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. In the heart, healthier blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack.
Researchers are also studying whether statin therapy could prevent venous thrombosis, which includes blood clots in the lungs (pulmonary embolism) or deep veins (deep vein thrombosis, or DVT).
Weighing the risks and benefits of statins
You should not take statins if you are pregnant or have some forms of advanced liver disease.
When thinking about whether you should take statins for high cholesterol, ask yourself these questions:
- Do I have other risk factors for cardiovascular disease?
- Am I willing and able to make lifestyle changes to improve my health?
- Am I concerned about taking a pill every day, perhaps for the rest of my life?
- Am I concerned about statins' side effects or interactions with other drugs?
It's important to consider your medical reasons, personal values, lifestyle choices and any concerns when choosing a treatment. Talk to your doctor about your total risk of cardiovascular disease and personal preferences before making a decision about statin therapy.
Nov. 09, 2018
See more In-depth
- Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement. JAMA [0098-7484] Bibbins Domingo yr:2016 vol:316 iss:19 pg:1997 -2007.
- Kazi DS, et al. Statins for primary prevention of cardiovascular disease: Review of evidence and recommendations for clinical practice. The Medical Clinics of North America. 2017;101:689.
- Selva-O'Callaghan A, et al. Statin-induced myalgia and myositis: An update on pathogenesis and clinical recommendations. Expert Review of Clinical Immunology. 2018;14:215.
- Arya S, et al. Statins have a dose-dependent effect on amputation and survival in peripheral artery disease patients. Circulation; In press. Accessed March 4, 2018.
- Wallace A, et al. Statins as a preventative therapy for venous thromboembolism. Cardiovascular Diagnosis & Therapy. 2017;7: S207.
- Rosenson RS. Management of low density lipoprotein cholesterol (LDL-C) in secondary prevention of cardiovascular disease. https://www.uptodate.com/contents/search. Accessed March 4, 2018.
- 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 4, 2018.
- Hennekens CH. Overview of primary prevention of coronary heart disease and stroke. https://www.uptodate.com/contents/search. Accessed March 4, 2018.
- 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 4, 2018.
- Rosenson RS, et al. Statin muscle-related adverse events. https://www.uptodate.com/contents/search. Accessed March 4, 2018.
- Rosenson RS. Statins: Actions, side effects, and administration. https://www.uptodate.com/contents/search. Accessed March 4, 2018.
- Rosenson RS. Statins: Possible noncardiovascular benefits. https://www.uptodate.com/contents/search. Accessed March 4, 2018.
- CDC. Know the facts about high cholesterol. https://www.cdc.gov/cholesterol/about.htm. Accessed May 8, 2018.
- Wilson PWF, et al. Cardiovascular disease risk assessment for primary prevention: Risk calculators. https://www.uptodate.com/contents/search. Accessed May 8, 2018.
- Lopez-Jimenez, F (expert opinion). Mayo Clinic, Rochester, Minn. June 18, 2018.