Statins: What You Need to Know

Cholesterol is a waxy, fat-like substance that travels through the blood. Too much can increase your risk for heart attack or stroke.

Our bodies make and need some cholesterol to work. But too much can hurt your heart health. Very high levels can promote the buildup of cholesterol, fat and other substances – also called plaque – in the walls of arteries. This buildup can block blood flow.

Unlike a headache, chest cold or stomach upset, high cholesterol usually has no symptoms. But it’s a big red flag when it comes to the chance that someone will develop heart or blood vessel problems.

Statins lower cholesterol in the blood by reducing the liver’s ability to make cholesterol. This allows the liver to accept more cholesterol from the blood, which in turn drives down cholesterol levels. They can drive down low-density lipoprotein (LDL) cholesterol levels – the “bad” cholesterol – by more than 50%.

Statins also help prevent heart attacks and strokes by keeping plaques from breaking apart and forming clots that can move to the heart or brain. In addition, they can lower triglycerides and boost high-density lipoprotein (HDL) cholesterol – known as the “good” cholesterol.

Statins work best when combined with a heart-healthy eating plan, regular exercise and other healthy habits.

Statins are often recommended to help prevent a first heart attack or stroke (called primary prevention).

They are also used to reduce the risk of having a repeat heart attack or stroke  in someone who has already had one (called secondary prevention).

In general, you should consider being on a statin if you: *

• Know you have heart disease or have a history of stroke, heart attack, peripheral vascular disease or chest pain, also called angina (this is to prevent further problems – called secondary prevention)
• Have high cholesterol (LDL of 190 mg/dL or higher) or know you have Familial Hypercholesterolemia (FH)
• Are between 40 and 75 years of age and also have diabetes
• Are between 40 and 75 years of age and your clinician estimates how likely you are to have a heart attack or stroke or die from one in the next 10 years (called your 10-year risk score), and your risk is high enough to benefit from being on one

_{* Note: Based on guidelines set forth by the American College of Cardiology and the American Heart Association}

If you or a loved one is over 75 years of age and have never been on a statin, the benefit of starting one is unclear. Talk with your health care team and decide what’s best.

Despite recommendations, many people are worried about taking a statin, most often due to fears of side effects they have read or heard about. But most people who take a statin do not have side effects. 

As with starting any medication, it is important to talk with your health care team, share concerns, and ask questions. For example:

• What are my risk factors? What is my calculated risk for a heart attack or stroke in the next 10 years?
• How will I benefit from taking a statin?
• How will we know if it’s working?
• Are there specific side effects I should watch for? Whom should I call if I notice them or have other concerns? When should I call?
• What else can I be doing to lower my chances of having a stroke or heart attack?

Learn more: Straight Talk about Statins
Learn more: Other LDL Cholesterol Treatments

Remember: If your health care team suggests that you take a statin, it’s all to help lower the chances that you will have a heart attack or stroke caused by atherosclerotic cardiovascular disease (ASCVD).

ASCVD develops because of a buildup of sticky, cholesterol-rich plaque. Over time, this plaque can build up and narrow the arteries.

Your care team may have already talked with you about how a risk calculator can be used to find your risk of developing ASCVD or having a heart attack or stroke. This calculator factors in things like:

• Your age
• Sex
• Race
• Cholesterol
• Systolic blood pressure (the top number)
• If you smoke
• If you have diabetes

Your care team may also consider other factors that play a role or affect your risk. Because your risk can change over time, it’s important to keep talking with your care team about what steps you can take to stay healthy as you age.

Keep in mind that making lifestyle changes – in addition to taking a statin or other medication – can help protect your heart and improve your overall health.

• Know why your health care team recommended a statin. If you have questions, ask.
• Share any concerns. Be open about any concerns that might get in the way of you actually filling the prescription or taking it the right way. For example, concerns about:
• Taking a daily medication (you might be unsure if this is your first)
• Adding yet another medication to the others you already take
• Possible side effects you’ve heard or read about
• Costs
• Report any side effects. Side effects are uncommon, but if you do have any, your health care team can try a new statin or change the dose (amount) you are taking. There are a lot of choices for you and your health care team. In some cases, your clinician may want to run other tests to find out if certain symptoms have other causes. For example, they might check your vitamin D or thyroid levels.
• Keep follow-up health visits. Most often, your health care team will start you on a high-intensity statin. At certain points in time, and especially a few weeks after starting one, they will want to check your blood work again, including your cholesterol levels to find out how the statin is working.
• Never stop taking your statin (or any prescription medicine) without talking with your health care team first.
• Ask if you should stay away from certain medications or foods. Certain drinks, foods and medications may change the way your statin – or other medications – work. For example, grapefruit juice can make some statins more potent and interacts with many other medications. Try not to drink grapefruit juice if you are taking a statin.
• Talk with your health care team if you are or plan to become pregnant.
• Update your medical history. Anytime you start a new therapy like a statin, it’s a good idea to tell your other health care team.

Assess and know your risk.

• Get your blood cholesterol levels checked
• Review with your health care team the other factors that raise your risk for heart attack and stroke

Begin treatment if you’re found to be at high risk for heart attack or stroke or already had either.

• You may not “feel” better taking a statin; that’s because it is to prevent problems
• Don’t stop taking a statin without talking with your health care team

Come back for repeat testing.

• After you’ve been on a statin for a few weeks (usually 6-8), blood tests can help find out how well it is working
• Treatment can be changed, as needed

Not all statins are the same. If you have a side effect with one or even more than one of the available statins, you still may be OK to take a lower amount (dose) of statin, a different statin or a (non-daily) longer-acting statin.

If statins aren’t enough to lower your ASCVD risk or you can’t take them for some reason, your health care team may recommend non-statin therapies.

These might include ezetimibe, which blocks cholesterol from being absorbed in the intestine, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or bempedoic acid.