Q&A With Heart Experts: In this series, heart specialists answer common questions about statins and heart health.
What is the importance of lowering cholesterol with a statin?
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 attack and stroke by 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.
How do we know statins save lives?
In the landmark JUPITER study, nearly 18,000 adults with low-density lipoprotein (LDL) cholesterol <130 mg/dL, which is typically not treated with medication, were followed for nearly two 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 with placebo. Statin users also saw their LDL cholesterol drop by 50% and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, decrease by 37% (Ridker et al 2008).
In a more recent research analysis, data from randomized trials of over 94,000 participants confirmed that statins as a group of medicines reduced cardiovascular risk while being generally safe for most people (Yebyo et al 2019). A systematic review of 22 randomized controlled trials found that statins provide an 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 research analysis focused on patients with diabetes demonstrated that statin use significantly lowered cardiovascular events, stroke, and all-cause mortality (Yang et al 2022). Together, these studies from diverse populations and rigorous methodologies provide compelling, high-certainty evidence for the cardiovascular-protective effects and safety of statins.
What is the evidence that statins prevent plaque rupture?
Clinical trials using advanced imaging techniques have shown statins not only lower cholesterol but also 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 buildup in heart arteries over 24 months. Similarly, the SATURN trial found both rosuvastatin and atorvastatin at high doses significantly reduced plaque. The PARADIGM study, which used coronary CT angiography, found statin users had slower progression of total plaque and fewer high-risk features. Finally, a research analysis of certain studies (VH-IVUS) 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.
Key Points
There is strong evidence that statins do more than lower LDL cholesterol, including stabilizing plaque.
These findings come from the most trusted types of studies – randomized controlled trials and large meta-analysis – providing strong evidence that statins can significantly lower the risk of heart attacks, strokes, and death – even in people without very high cholesterol.
Read More: Q&A With Heart Experts: Statins