Q&A With Heart Experts: What Is the Importance of Lowering Cholesterol With a Statin?

In this series, heart specialists answer common questions about statins and heart health.

Question: What is the importance of lowering cholesterol with a statin?

Answer: Heart attacks and strokes often happen because of atherosclerosis, a condition where cholesterol builds up in the walls of the arteries, forming what is called plaque. Over time, this plaque can narrow or block blood flow to important organs like the heart, kidneys, and brain. Even more dangerous, these plaques can sometimes rupture, leading to a sudden heart attack or stroke. Statins are medications that help lower cholesterol levels in the blood. They reduce the risk of heart attacks and strokes by both slowing down the buildup of new plaque and stabilizing existing plaque, making it less likely to break apart and cause a heart attack or stroke.   

Question: How do we know statins save lives?

Answer: In a landmark study, JUPITER, nearly 18,000 adults with LDL cholesterol <130 mg/dL, which is typically not treated with medication,    were followed for about 1.9 years. Participants taking rosuvastatin 20 mg daily experienced a remarkable 44% reduction in major cardiovascular events—like heart attack, stroke, and artery procedures—and a 20% lower death compared to placebo. Statin users also saw their LDL cholesterol  drop by 50% and inflammatory marker, hsCRP, decrease by 37% (Ridker et al 2008).

In a more recent network meta-analysis , data from randomized trials of 94,283 participants confirmed statins as a drug class markedly reduced cardiovascular risk with a favorable safety profile (Yebyo et al 2019). A JAMA systematic review —including 22 randomized controlled trials—found that statins provide a 8% relative risk reduction in all-cause death over one year, and a 28% reduction in major cardiovascular events, all with no significant increase in side effects (Chou et al 2022). Finally, a meta-analysis focused on diabetic patients demonstrated that statin use significantly lowered cardiovascular events, stroke, and all-cause mortality (Yang et al 2022). Together, these well-powered studies from perse populations and rigorous methodologies provide compelling, high certainty evidence for cardiovascular protective effects and safety of statins.   

Question: What is the evidence that statins prevent plaque rupture?

Answer: Clinical trials using advanced imaging techniques have shown statins not only lower cholesterol but actively stabilize and sometimes reverse atherosclerotic plaque. The ASTEROID trial demonstrated high dose rosuvastatin (40 mg/day) led to a significant regression in the amount of plaque build up in the heart arteries over 24 months. Similarly, the SATURN trial found both rosuvastatin and atorvastatin at high doses significantly reduced plaque burden. The PARADIGM study, which used coronary CT angiography, found statin users had slower progression of total plaque and fewer high-risk features. Finally, a meta-analysis  of VH-IVUS studies revealed statins reduced the fibrous and fibro-fatty components of plaques while increasing dense calcium content, supporting the idea that statins transform plaques into a more stable, less rupture-prone form. 

Read More: Q&A With Heart Experts: Statins