Are Statins Worth Taking for High Cholesterol?

January 19, 2023

Tens of millions of U.S. adults take cholesterol-lowering medications, but only half of adults who could benefit from the drugs take them. Many are concerned about potential side effects, including an increased risk of developing type 2 diabetes.

Most people do not experience significant side effects from statins, says cardiologist Ian Neeland, MD, director for the Center of Cardiovascular Prevention at University Hospitals. Dr. Neeland answers some common questions about cholesterol, and the benefits of statins.

What is cholesterol and how does it pose a health threat?

Cholesterol is a lipid (fat-like) substance that helps your body make cell membranes, hormones and vitamin D. Cholesterol is produced by the liver and also comes from foods you eat. Genetics play a role in how much cholesterol your liver makes and reabsorbs from your bloodstream.

Cholesterol circulates in the blood as round particles called lipoproteins. The two most commonly known are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL or bad cholesterol contributes to the formation of plaque buildup in the arteries. That condition is called atherosclerosis, which is linked to higher risk for heart disease and stroke.

What do we know about cholesterol-lowering drugs?

Statins and other lipid-lowering medications can alter how your liver handles cholesterol and drive down bad cholesterol to very low levels.

Decades of research has proven that statins and other lipid-lowering therapies are very effective in reducing the risk for major vascular events, such as death from cardiovascular causes, heart attack, stroke, or needing a coronary stent or bypass surgery.

We have data now from over 20 statin trials of over 135,000 patients that show statins compared with placebo or no medication result in a 23 percent reduction in heart attacks, 17 percent reduction in fatal or non-fatal stroke and 19 percent reduction in death from cardiovascular causes.

So, they definitely work. They're definitely effective at preventing heart disease and death.

What about side effects?

Although there are some potential side effects long-term for statins, in most cases, if your doctor has identified you as having high cholesterol and needing a statin, the benefits greatly outweigh the risks.

Muscle aches are among the most common complaints. Muscle aches are not dangerous, but may cause discomfort for some patients. Side effects are infrequent, and most people can manage them and stay on some dose of a statin for long-term benefit. There are cases of liver or muscle injury, but those cases are extremely rare.

We know that for every 255 patients taking a statin for four years, one may be diagnosed with new Type 2 diabetes. That usually occurs in people already at risk for diabetes. They may have pre-diabetes or may be very overweight. They are likely to develop diabetes regardless of the statin medication.

And the benefits of long-term use of statins?

The longer you use lipid-lowering medications and have lower cholesterol, the bigger the benefit is. For example, 10 years on a statin with low LDL cholesterol might decrease your risk by 20 percent; at 30 years it’s 40 percent; and at 50 years it’s 60 percent.

Someone in their 30s who wants to really make a dent in their long-term risk, especially if they have family history of cardiovascular disease or they have other risk factors, will get the biggest benefit over time. Their trajectory for heart disease will change drastically and dramatically by lowering their LDL cholesterol.

Can’t you lower cholesterol through diet and exercise?

It’s all about understanding an individual’s long-term risk. People who are younger, who don’t have any risk factors for heart disease, can usually get away with lifestyle changes – diet and exercise. There are people and families with genetic changes that make them have very low LDL cholesterol, less than 20. Those people almost never get heart disease.

But as you age or develop risk factors like high blood pressure or obesity, that would increase your risk of heart disease and would be an indication to go on a statin. People who have heart disease, diabetes, very high LDL, or have strong family history of early-onset coronary disease should be on a statin.

Changing your eating habits – decreasing saturated fat and cholesterol in your diet, increasing soluble fiber, fruits and vegetables – and regular exercise are important. Lifestyle changes and weight loss can lower your LDL cholesterol, improve your triglycerides and raise your HDL (good) cholesterol. In general, the effects are modest – usually about a 10 to 20 percent change – whereas statins can reduce your LDL cholesterol by more than 50 percent in many cases.

Your advice to patients concerned about side effects?

The most important thing is to discuss questions and concerns with your doctor. Even if you’re experiencing side effects, there are adjustments your doctor can make, such as tweaking the dose of your statin or switching to a different statin medication. Many of these changes can address the side effects you’re worried about.

It's really important to have the correct information and to feel comfortable in understanding what it means to take a statin. It’s also important to understand what the myths and the facts about statin medications. Your doctor can help you understand the risks and the benefits of taking statins as well as other medications to prevent heart disease and stroke.