How to know if you should take statins to lower your cholesterol — and whether they are safe and effective
- Statins are considered a safe and effective medication to lower cholesterol.
- However, statins aren't necessary for everyone to lower cholesterol, and only your doctor can help determine if this medication is right for you.
- Here's how you can know if you should be taking statins, and how to use them safely.
- This article was medically reviewed by John Osborne, MD, PhD, and the Director of Cardiology for Dallas-based State of the Heart Cardiology.
High cholesterol is one of the biggest risk factors for cardiovascular disease, which is the leading cause of death in the US. Every year, about one in three Americans will die from a heart attack or stroke.
To help prevent these deaths, drugs like statins can lower cholesterol, which stops unhealthy fat from building up and blocking your arteries. According to the American Heart Association (AHA), statins are the only cholesterol-lowering drugs directly associated with reduced risks of heart attacks or strokes.
More than 35 million people in the US are taking statins. These drugs, which are available only by prescription, come in tablet and capsule forms. Here's what you need to know about the safety and effectiveness of statins, and whether you should be taking one to lower cholesterol.
What are statins?
Statins, which are also known as HMG-CoA reductase inhibitors, help prevent your body from making low-density lipoprotein (LDL) cholesterol, also known as "bad cholesterol."
If you have too much LDL cholesterol in your blood, it can cause plaque to build up in your arteries. This process is known as atherosclerosis and it can create blockages that increase your risk for the following conditions:
Statins block an enzyme in your liver from producing LDL cholesterol and also help your liver remove LDL cholesterol that's already in your blood. In addition, statins help your body absorb cholesterol that has built up on the walls of your arteries, reducing the possibility of those blockages and dangerous heart conditions.
These drugs can also help raise the level of high-density lipoprotein (HDL) cholesterol, or "good cholesterol," in your blood. HDL cholesterol helps your body get rid of LDL cholesterol.
Overall, statins have proven to be effective in helping to prevent heart attacks and strokes. Evidence from randomized trials has found they reduce the risk of cardiovascular events by about 25% every year for each milligram of cholesterol lowered per deciliter of blood (mg/dL).
Who needs to take statins?
In 2018, experts including the AHA and American College of Cardiology released guidelines recommending that doctors prescribe statins to people in the following four high-risk groups:
- People who have cardiovascular disease
- People with a high LDL cholesterol level (over 190 mg/dL)
- People who are between 40 and 75 years of age and have type 2 diabetes
- People between 40 and 75 years of age who have at least a 7.5% risk of getting cardiovascular disease in the next 10 years
Statins are usually prescribed to people who have had a heart attack or stroke, or are at higher risk for having one, such as smokers and people with high blood pressure or diabetes.
Statins may also be prescribed for people who have high cholesterol levels as a result of genetics. This inherited condition called familial hypercholesterolemia (FH) causes some people to produce too much LDL, or bad, cholesterol. Children with FH may also be prescribed statins.
Types of statin therapy
The guideline divides statin therapies into three intensity categories, based on how much LDL cholesterol is lowered with a daily dose:
- High intensity lowers LDL by at least 50%. It is generally prescribed to people with a history of cardiovascular disease or whose LDL level is higher than 190 mg/dL.
- Medium intensity lowers it from 30% to 49%. It is generally prescribed to people whose LDL level is between 70 and 190 mg/dL, or who have at least one risk factor for cardiovascular disease and at least a 10% possibility of having a heart attack or stroke in the next 10 years.
- Low intensity lowers it less than 30%. It is usually prescribed to people between the ages of 40 and 75 who don't have a history of heart disease, but have at least one risk factor for cardiovascular disease and a 7.5% to 10% possibility of having a heart attack or stroke in the next 10 years.
The following are some of the statins and daily dosages that should be prescribed, according to the guideline. Statins, which are also available in generic versions, have varying potencies.
For example, Crestor (rosuvastatin) and Lipitor (atorvastatin) are the most potent statins and the most effective in reducing cholesterol. Altoprev (lovastatin) and Pravachol (pravastatin) are the least potent statins, and are usually prescribed when other, high-intensity statins are not able to be well tolerated.
High-intensity statin therapy
- Crestor (rosuvastatin): 20 to 40 mg (milligrams)
- Lipitor (atorvastatin): 40 to 80 mg
Medium-intensity statin therapy
- Lescol (fluvastatin): 40 mg twice daily
- Zocor (simvastatin): 20 to 40 mg
Low-intensity statin therapy
- Altoprev (lovastatin): 20 mg
- Pravachol (pravastatin): 10 to 20 mg
Side effects of statins
"Statins have been on the market for at least three decades and at least from what we know from long-term studies, they appear to be very safe," says cardiologist Eugene Yang, MD, medical director of the UW Medicine Eastside Specialty Center and chair-elect of the ACC Prevention of Cardiovascular Disease Council.
However, there are also some known side effects of statins. These include:
- Muscle or joint pain, soreness, or weakness
- Headache
- Nausea
- Constipation
- Dizziness
In addition, the following side effects are more serious, but rarely occur:
- A slight increase in your blood sugar level, which could lead to type 2 diabetes
- Liver damage
- Muscle cell damage
Some types of statin medications are known for certain side effects. For example, Zocor (simvastatin) may be more likely to cause muscle pain than other statins. Lescol (fluvastatin) may be less likely to cause muscle pain. If you have liver disease, or are pregnant, your doctor may not recommend statins.
How to take statins safely
If you're taking statins, be sure to let your doctor know about any other medications or over-the-counter supplements you're using. Some medications and supplements, such as birth control pills or niacin, can interfere with the effectiveness of cholesterol medications and increase the risk of side effects.
It's important to avoid excessive consumption of alcohol while you're taking statins. "Alcohol affects the liver, so doing things that avoid injury to the liver is definitely something we promote," Yang says.
The US Food and Drug Administration (FDA) also warns that you should avoid drinking grapefruit juice or eating grapefruit if you're taking some statins, such as Lipitor or Zocor. That's because grapefruit juice can stop an enzyme in your small intestine from breaking down the drug, which allows more of the drug to enter your blood and stay in your body longer.
"It's really about being moderate in your intake," Yang says. "In general, if somebody eats half a grapefruit a day with their breakfast, it's not going to have a significant impact on the metabolism of cholesterol medications."
Takeaways
Based on decades of scientific research, the benefits of taking statins far outweigh any risk of side effects, the AHA stated in a 2018 report. However, it's important to understand that stains won't lower cholesterol on its own — you also need to adopt heart-healthy behaviors.
"The key thing is that these medications are basically being prescribed to be an adjunct to healthy lifestyles and behaviors," Yang says. "We're advocating for people to eat foods that are low in saturated fat and high in healthy, unsaturated fat. The medication is not to be used to allow people to eat whatever they want, but it should be taken in conjunction with good dietary habits."
Read more about how to lower cholesterol with the right diet and exercise regimens.