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High Cholesterol: Should I Take Statins?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

High Cholesterol: Should I Take Statins?

Get the facts

Your options

  • Start taking medicine for high cholesterol.
  • Don't take medicine. Try lowering your cholesterol with lifestyle changes.

Key points to remember

  • You may be able to improve your high cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take medicines called statins or statin combinations to lower your cholesterol.
  • If you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, you may need to start taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.
  • Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol.
  • Statins can lower your risk of having a heart attack or a stroke.
  • Statins have few side effects. Any side effects, such as muscle aches, feeling tired, or having an upset stomach, are most likely when higher doses are used. Statins don't cause side effects in most people.
  • Even with medicine, you will need healthy habits for the rest of your life to lower your risk of a heart attack.
FAQs

What is high cholesterol?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But if you have too much, it starts to build up in your arteries. The higher your cholesterol, the greater your risk for heart disease. Too much cholesterol in your blood can lead to a heart attack or a stroke.

There are two kinds of cholesterol:

  • Low-density lipoproteins (LDL) are the "bad" cholesterol. LDL can clog your arteries.
  • High-density lipoproteins (HDL) are the "good" cholesterol. HDL helps clear fat from your blood.

Triglycerides are another type of fat in the blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

A simple blood test tells you how much cholesterol you have. The test results are given in numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To find out this risk, your doctor will also consider your age, your family history, your blood pressure, and if you smoke.

  • LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
  • HDL should be high. A good HDL goal is 40 or higher. An HDL level of 60 or higher is linked to a lower risk of heart disease. A high HDL number can help offset a high LDL number.
  • Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What increases your risk for heart disease and heart attack?

High cholesterol is just one of several risk factors that make heart attacks or strokes more likely. If you have high cholesterol and another risk factor, heart attacks and strokes are even more likely. Some risk factors are things you may be able to control. Others are things you can't control.

Your doctor can help you know your risk of a heart attack or stroke.

Risk factors you may be able to control include:

  • Diabetes.
  • High cholesterol.
  • High blood pressure.
  • Smoking cigarettes.
  • Being overweight.
  • Not exercising.

Risk factors that you can't control include:

  • Your age. Men age 45 or older and women age 55 or older have a higher risk.
  • Having one or more close relatives who have or had early heart disease.

How is high cholesterol treated?

The two main treatments for high cholesterol are medicines called statins and the Therapeutic Lifestyle Changes (TLC) program, which includes being more active and changing your diet. The main goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack or a stroke.

The way high cholesterol is treated will depend on your risk for a heart attack and your personal preference about taking medicines. For example:

  • For people who are at moderate to high risk of a heart attack, research shows that statins lower the risk of heart attack and stroke. For these people, the United States National Cholesterol Education Panel (NCEP) recommends that they start taking statins right away.2, 3
  • For people who are at low risk of a heart attack, experts are not sure how well statins lower this risk.4 For these people, the NCEP recommends lifestyle changes as the first option to lower cholesterol.2

If you try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try changing your diet and activity level for 3 to 6 months. If your cholesterol doesn't come down enough in that time, you may decide to start taking statins.

Why are lifestyle changes so important?

Some people can lower their cholesterol just by making lifestyle changes such as eating less saturated fat, losing weight, exercising, and quitting smoking. Others will need to take pills as well. But some lifestyle changes are important for everyone with high cholesterol. Even with statins, you will need healthy habits for the rest of your life to lower your risk of a heart attack.

What are the benefits of statins?

Statins and statin combinations are medicines that reduce the body's natural production of cholesterol. They make "bad" LDL cholesterol levels in the blood go down and help lower your triglycerides. Statins can also raise "good" HDL cholesterol. Statins may be used alone, or they may be combined with other medicines.

Statins and statin combinations can:

  • Lower the risk of heart attack.5
  • Lower stroke risk.5
  • Reduce LDL.2
  • Increase HDL.2
  • Reduce triglycerides.2

What are the risks and side effects of statins?

Statins don't cause side effects in most people.

When side effects happen, they tend to include minor problems such as:

  • Muscle aches.
  • Tiredness.
  • Upset stomach.

These may be bothersome but are not serious. Serious side effects are rare. These include liver and muscle problems, diabetes, and temporary memory problems.6

What do numbers tell us about benefits and risks of statins?

Benefits if you have heart disease
Effects of statins for people who have heart disease*
Risks within next 3 to 5 years With statins Without statins
Death from any cause 8 to 9 out of 100 11 to 12 out of 100
Death from heart or blood vessel problems 3 to 4 out of 100 8 to 9 out of 100
Nonfatal heart attack 5 to 6 out of 100 8 to 9 out of 100

*Based on the best available evidence (evidence quality: moderate)

Evidence shows that statins help people with heart disease by reducing the risk of death and heart attack. The quality of this evidence is moderate.

Take a group of 100 people who have heart disease. Here is their risk of death from any cause within the next 3 to 5 years:

  • Without statins, 11 to 12 out of 100 people with heart disease will die. This means that 88 to 89 out of 100 will not.
  • With statins, 8 to 9 out of 100 will die. This means that 91 to 92 will not.

Here is their risk of death from heart or blood vessel disease within the next 3 to 5 years:

  • Without statins, 8 to 9 out of 100 people with heart disease will die from a heart or blood vessel problem. This means that 91 to 92 out of 100 will not.
  • With statins, 3 to 4 out of 100 will die from a heart or blood vessel problem. This means that 96 to 97 out of 100 will not.

And here is their risk of a nonfatal heart attack (a heart attack that doesn't cause death) within the next 3 to 5 years:

  • Without statins, about 8 to 9 out of 100 people will have a nonfatal heart attack. This means that about 91 to 92 out of 100 will not have one.
  • With statins, 5 to 6 out of 100 people will have a nonfatal heart attack. This means that 94 to 95 out of 100 will not.
Benefits if you don't have heart disease
Effects of statins for people who don't have heart disease*
Risks within next 3 to 5 years With statins Without statins
Death from any cause 3 to 4 out of 100 4 to 5 out of 100
Nonfatal heart attack 1 to 2 out of 100 2 to 3 out of 100

*Based on the best available evidence (evidence quality: borderline)

Evidence shows that statins may be helpful for people who don't have heart disease. The quality of this evidence is borderline.

Take a group of 100 people who don't have heart disease. Here is their risk of death from any cause within the next 3 to 5 years:

  • Without statins, 4 to 5 out of 100 may die. This means that 95 to 96 out of 100 may not.
  • With statins, 3 to 4 out of 100 may die. This means that 96 to 97 out of 100 may not.

And here is their risk of a nonfatal heart attack within the next 3 to 5 years:

  • Without statins, about 2 to 3 out of 100 people may have a nonfatal heart attack. This means that about 97 to 98 out of 100 may not have one.
  • With statins, 1 to 2 out of 100 people may have a nonfatal heart attack. This means that about 98 to 99 out of 100 may not.
Risks

Most evidence shows that statins are safe.

Some studies suggest that statins may increase your risk of diabetes, liver problems, and a rare muscle problem called rhabdomyolysis. But this evidence is not clear. It is inconclusive.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.4, 1, 7, 8, 9, 10, 11, 12The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend taking statins?

Your doctor may recommend that you take statins or statin combinations if the benefits of statins outweigh the risks. Benefits might outweigh risks if:

  • You have high "bad" LDL cholesterol and low "good" HDL cholesterol.
  • You have diabetes, high blood pressure, or heart disease.
  • You are at high risk of having a heart attack, or you already have heart problems.
  • You have tried being more active and changing your diet, but these changes didn't lower your cholesterol enough.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take statins to lower your cholesterol Take statins to lower your cholesterol
  • You take a pill every day.
  • Studies show that statins and statin combinations can:
    • Lower "bad" LDL cholesterol and increase "good" HDL cholesterol.
    • Lower the risk of a heart attack.
    • Lower the risk of a stroke.
  • Statins don't cause side effects in most people.
  • Side effects are typically not serious. But they can be bothersome (muscle aches, tiredness, upset stomach).
  • These medicines can be costly.
Don't take statins Don't take statins
  • You try being more active, changing your diet, and making other lifestyle changes (Therapeutic Lifestyle Changes, or TLC).
  • You may be able to lower your cholesterol by making healthy changes.
  • You avoid taking pills every day.
  • You avoid the cost of pills.
  • Lifestyle changes may not be enough to lower your cholesterol.
  • You may still be at risk for a heart attack or a stroke if your cholesterol is too high.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Stories about deciding whether to use medicine for high cholesterol

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I don't like taking pills all the time, and I would have to take the cholesterol medicines for the rest of my life to keep getting any benefit from them. My only other risk factor is high blood pressure. I need to eat a low-fat diet and get enough exercise to help keep my weight under control, so I'm going to see if I can get my cholesterol down a little bit that way (and maybe help my blood pressure, too).

Carole, age 58

My dad died of a heart attack when he was in his 50s. I must have inherited my high cholesterol from him. I don't want to die before my time, and I haven't been able to get my cholesterol down very much by eating a low-fat diet. I am going to try the medicines.

Charles, age 48

Heart disease runs in our family, so I know I need to be concerned about my cholesterol and all those other risk factors. The most important thing for me right now is to quit smoking. From what I have read, quitting smoking will help reduce my risk of heart disease, lung cancer, and other problems. And it might help just as much as lowering my cholesterol would help. It will also be better for my family and will save money.

Diego, age 41

I just found out that I have high cholesterol. Being a smoker, my risk of heart disease is already higher, and now I have another risk factor to worry about. I have tried many times to quit smoking, but it has never worked. I want to reduce my risk of heart disease, so I would like to try taking medicines. If I have some success with that, maybe it will help motivate me to finally quit smoking.

Becky, age 56

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.

I want to try to make lifestyle changes to help lower my cholesterol.

More important
Equally important
More important

I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.

I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.

More important
Equally important
More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important
Equally important
More important

I worry about having a heart attack, and I want to do everything I can to prevent it.

I'm not that worried about having a heart attack.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is taking medicine the only way to lower your cholesterol?

  • YesSorry, that's not right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • NoYou're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • I'm not sureIt may help to go back and read "Get the Facts." You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weigh, exercising, and quitting smoking.
2.

Can statin medicines help you lower your risk of having a heart attack or stroke?

  • YesYou're right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
  • NoSorry, that's not right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
  • I'm not sureIt may help to go back and read "Get the Facts." Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
3.

Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?

  • YesYou're right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.
  • NoSorry, that's not right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.
  • I'm not sureIt may help to go back and read "Get the Facts." Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology

References
Citations
  1. Tonelli M, et al. (2011). Efficacy of statins for primary prevention in people at low cardiovascular risk: A meta-analysis. Canadian Medical Association Journal, 183(16): e1189–e1202.
  2. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
  3. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
  4. Taylor F, et al. (2011). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews (8).
  5. Drugs for lipids (2011). Treatment Guidelines From The Medical Letter,9(103): 13–20.
  6. Statin label changes (2012). Medical Letter on Drugs and Therapeutics, 54(1386): 21.
  7. Alberton M, et al. (2012). Adverse events associated with individual statin treatments for cardiovascular disease: An indirect comparison meta-analysis. QJM: An International Journal of Medicine, 105(2): 145–157.
  8. Bonovas S, et al. (2006). Statins and cancer risk: A literature-based meta-analysis and meta-regression analysis of 35 randomized controlled trials. Journal of Clinical Oncology, 24(30): 4808–4817.
  9. Hayward RA, et al. (2006). Narrative review: Lack of evidence for recommended low-density lipoprotein treatment targets: A solvable problem. Annals of Internal Medicine, 145(7): 520–530.
  10. Mills EJ, et al. (2011). Efficacy and safety of statin treatment for cardiovascular disease: A network meta-analysis of 170,255 patients from 76 randomized trials. QJM: An International Journal of Medicine, 104(2): 109–124.
  11. Shepherd J, et al. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial. Lancet, 360(9346): 1623–1630.
  12. Ward S, et al. (2007). A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technology Assessment, 11(14): 1–160, iii–iv.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

High Cholesterol: Should I Take Statins?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Start taking medicine for high cholesterol.
  • Don't take medicine. Try lowering your cholesterol with lifestyle changes.

Key points to remember

  • You may be able to improve your high cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take medicines called statins or statin combinations to lower your cholesterol.
  • If you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, you may need to start taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.
  • Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol.
  • Statins can lower your risk of having a heart attack or a stroke.
  • Statins have few side effects. Any side effects, such as muscle aches, feeling tired, or having an upset stomach, are most likely when higher doses are used. Statins don't cause side effects in most people.
  • Even with medicine, you will need healthy habits for the rest of your life to lower your risk of a heart attack.
FAQs

What is high cholesterol?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But if you have too much, it starts to build up in your arteries. The higher your cholesterol, the greater your risk for heart disease. Too much cholesterol in your blood can lead to a heart attack or a stroke.

There are two kinds of cholesterol:

  • Low-density lipoproteins (LDL) are the "bad" cholesterol. LDL can clog your arteries.
  • High-density lipoproteins (HDL) are the "good" cholesterol. HDL helps clear fat from your blood.

Triglycerides are another type of fat in the blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

A simple blood test tells you how much cholesterol you have. The test results are given in numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To find out this risk, your doctor will also consider your age, your family history, your blood pressure, and if you smoke.

  • LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
  • HDL should be high. A good HDL goal is 40 or higher. An HDL level of 60 or higher is linked to a lower risk of heart disease. A high HDL number can help offset a high LDL number.
  • Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What increases your risk for heart disease and heart attack?

High cholesterol is just one of several risk factors that make heart attacks or strokes more likely. If you have high cholesterol and another risk factor, heart attacks and strokes are even more likely. Some risk factors are things you may be able to control. Others are things you can't control.

Your doctor can help you know your risk of a heart attack or stroke.

Risk factors you may be able to control include:

  • Diabetes.
  • High cholesterol.
  • High blood pressure.
  • Smoking cigarettes.
  • Being overweight.
  • Not exercising.

Risk factors that you can't control include:

  • Your age. Men age 45 or older and women age 55 or older have a higher risk.
  • Having one or more close relatives who have or had early heart disease.

How is high cholesterol treated?

The two main treatments for high cholesterol are medicines called statins and the Therapeutic Lifestyle Changes (TLC) program, which includes being more active and changing your diet. The main goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack or a stroke.

The way high cholesterol is treated will depend on your risk for a heart attack and your personal preference about taking medicines. For example:

  • For people who are at moderate to high risk of a heart attack, research shows that statins lower the risk of heart attack and stroke. For these people, the United States National Cholesterol Education Panel (NCEP) recommends that they start taking statins right away.2, 3
  • For people who are at low risk of a heart attack, experts are not sure how well statins lower this risk.4 For these people, the NCEP recommends lifestyle changes as the first option to lower cholesterol.2

If you try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try changing your diet and activity level for 3 to 6 months. If your cholesterol doesn't come down enough in that time, you may decide to start taking statins.

Why are lifestyle changes so important?

Some people can lower their cholesterol just by making lifestyle changes such as eating less saturated fat, losing weight, exercising, and quitting smoking. Others will need to take pills as well. But some lifestyle changes are important for everyone with high cholesterol. Even with statins, you will need healthy habits for the rest of your life to lower your risk of a heart attack.

What are the benefits of statins?

Statins and statin combinations are medicines that reduce the body's natural production of cholesterol. They make "bad" LDL cholesterol levels in the blood go down and help lower your triglycerides. Statins can also raise "good" HDL cholesterol. Statins may be used alone, or they may be combined with other medicines.

Statins and statin combinations can:

  • Lower the risk of heart attack.5
  • Lower stroke risk.5
  • Reduce LDL.2
  • Increase HDL.2
  • Reduce triglycerides.2

What are the risks and side effects of statins?

Statins don't cause side effects in most people.

When side effects happen, they tend to include minor problems such as:

  • Muscle aches.
  • Tiredness.
  • Upset stomach.

These may be bothersome but are not serious. Serious side effects are rare. These include liver and muscle problems, diabetes, and temporary memory problems.6

What do numbers tell us about benefits and risks of statins?

Benefits if you have heart disease
Effects of statins for people who have heart disease*
Risks within next 3 to 5 years With statins Without statins
Death from any cause 8 to 9 out of 100 11 to 12 out of 100
Death from heart or blood vessel problems 3 to 4 out of 100 8 to 9 out of 100
Nonfatal heart attack 5 to 6 out of 100 8 to 9 out of 100

*Based on the best available evidence (evidence quality: moderate)

Evidence shows that statins help people with heart disease by reducing the risk of death and heart attack. The quality of this evidence is moderate.

Take a group of 100 people who have heart disease . Here is their risk of death from any cause within the next 3 to 5 years:

  • Without statins, 11 to 12 out of 100 people with heart disease will die. This means that 88 to 89 out of 100 will not.
  • With statins, 8 to 9 out of 100 will die. This means that 91 to 92 will not.

Here is their risk of death from heart or blood vessel disease within the next 3 to 5 years:

  • Without statins, 8 to 9 out of 100 people with heart disease will die from a heart or blood vessel problem. This means that 91 to 92 out of 100 will not.
  • With statins, 3 to 4 out of 100 will die from a heart or blood vessel problem. This means that 96 to 97 out of 100 will not.

And here is their risk of a nonfatal heart attack (a heart attack that doesn't cause death) within the next 3 to 5 years:

  • Without statins, about 8 to 9 out of 100 people will have a nonfatal heart attack. This means that about 91 to 92 out of 100 will not have one.
  • With statins, 5 to 6 out of 100 people will have a nonfatal heart attack. This means that 94 to 95 out of 100 will not.
Benefits if you don't have heart disease
Effects of statins for people who don't have heart disease*
Risks within next 3 to 5 years With statins Without statins
Death from any cause 3 to 4 out of 100 4 to 5 out of 100
Nonfatal heart attack 1 to 2 out of 100 2 to 3 out of 100

*Based on the best available evidence (evidence quality: borderline)

Evidence shows that statins may be helpful for people who don't have heart disease. The quality of this evidence is borderline.

Take a group of 100 people who don't have heart disease . Here is their risk of death from any cause within the next 3 to 5 years:

  • Without statins, 4 to 5 out of 100 may die. This means that 95 to 96 out of 100 may not.
  • With statins, 3 to 4 out of 100 may die. This means that 96 to 97 out of 100 may not.

And here is their risk of a nonfatal heart attack within the next 3 to 5 years:

  • Without statins, about 2 to 3 out of 100 people may have a nonfatal heart attack. This means that about 97 to 98 out of 100 may not have one.
  • With statins, 1 to 2 out of 100 people may have a nonfatal heart attack. This means that about 98 to 99 out of 100 may not.
Risks

Most evidence shows that statins are safe.

Some studies suggest that statins may increase your risk of diabetes, liver problems, and a rare muscle problem called rhabdomyolysis. But this evidence is not clear. It is inconclusive.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.4, 1, 7, 8, 9, 10, 11, 12The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend taking statins?

Your doctor may recommend that you take statins or statin combinations if the benefits of statins outweigh the risks. Benefits might outweigh risks if:

  • You have high "bad" LDL cholesterol and low "good" HDL cholesterol.
  • You have diabetes, high blood pressure, or heart disease.
  • You are at high risk of having a heart attack, or you already have heart problems.
  • You have tried being more active and changing your diet, but these changes didn't lower your cholesterol enough.

2. Compare your options

  Take statins to lower your cholesterol Don't take statins
What is usually involved?
  • You take a pill every day.
  • You try being more active, changing your diet, and making other lifestyle changes (Therapeutic Lifestyle Changes, or TLC).
What are the benefits?
  • Studies show that statins and statin combinations can:
    • Lower "bad" LDL cholesterol and increase "good" HDL cholesterol.
    • Lower the risk of a heart attack.
    • Lower the risk of a stroke.
  • You may be able to lower your cholesterol by making healthy changes.
  • You avoid taking pills every day.
  • You avoid the cost of pills.
What are the risks and side effects?
  • Statins don't cause side effects in most people.
  • Side effects are typically not serious. But they can be bothersome (muscle aches, tiredness, upset stomach).
  • These medicines can be costly.
  • Lifestyle changes may not be enough to lower your cholesterol.
  • You may still be at risk for a heart attack or a stroke if your cholesterol is too high.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Stories about deciding whether to use medicine for high cholesterol

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I don't like taking pills all the time, and I would have to take the cholesterol medicines for the rest of my life to keep getting any benefit from them. My only other risk factor is high blood pressure. I need to eat a low-fat diet and get enough exercise to help keep my weight under control, so I'm going to see if I can get my cholesterol down a little bit that way (and maybe help my blood pressure, too)."

— Carole, age 58

"My dad died of a heart attack when he was in his 50s. I must have inherited my high cholesterol from him. I don't want to die before my time, and I haven't been able to get my cholesterol down very much by eating a low-fat diet. I am going to try the medicines."

— Charles, age 48

"Heart disease runs in our family, so I know I need to be concerned about my cholesterol and all those other risk factors. The most important thing for me right now is to quit smoking. From what I have read, quitting smoking will help reduce my risk of heart disease, lung cancer, and other problems. And it might help just as much as lowering my cholesterol would help. It will also be better for my family and will save money."

— Diego, age 41

"I just found out that I have high cholesterol. Being a smoker, my risk of heart disease is already higher, and now I have another risk factor to worry about. I have tried many times to quit smoking, but it has never worked. I want to reduce my risk of heart disease, so I would like to try taking medicines. If I have some success with that, maybe it will help motivate me to finally quit smoking."

— Becky, age 56

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.

I want to try to make lifestyle changes to help lower my cholesterol.

             
More important
Equally important
More important

I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.

I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.

             
More important
Equally important
More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

             
More important
Equally important
More important

I worry about having a heart attack, and I want to do everything I can to prevent it.

I'm not that worried about having a heart attack.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is taking medicine the only way to lower your cholesterol?

  • Yes
  • No
  • I'm not sure
You're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.

2. Can statin medicines help you lower your risk of having a heart attack or stroke?

  • Yes
  • No
  • I'm not sure
You're right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.

3. Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?

  • Yes
  • No
  • I'm not sure
You're right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology

References
Citations
  1. Tonelli M, et al. (2011). Efficacy of statins for primary prevention in people at low cardiovascular risk: A meta-analysis. Canadian Medical Association Journal, 183(16): e1189–e1202.
  2. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
  3. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
  4. Taylor F, et al. (2011). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews (8).
  5. Drugs for lipids (2011). Treatment Guidelines From The Medical Letter,9(103): 13–20.
  6. Statin label changes (2012). Medical Letter on Drugs and Therapeutics, 54(1386): 21.
  7. Alberton M, et al. (2012). Adverse events associated with individual statin treatments for cardiovascular disease: An indirect comparison meta-analysis. QJM: An International Journal of Medicine, 105(2): 145–157.
  8. Bonovas S, et al. (2006). Statins and cancer risk: A literature-based meta-analysis and meta-regression analysis of 35 randomized controlled trials. Journal of Clinical Oncology, 24(30): 4808–4817.
  9. Hayward RA, et al. (2006). Narrative review: Lack of evidence for recommended low-density lipoprotein treatment targets: A solvable problem. Annals of Internal Medicine, 145(7): 520–530.
  10. Mills EJ, et al. (2011). Efficacy and safety of statin treatment for cardiovascular disease: A network meta-analysis of 170,255 patients from 76 randomized trials. QJM: An International Journal of Medicine, 104(2): 109–124.
  11. Shepherd J, et al. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial. Lancet, 360(9346): 1623–1630.
  12. Ward S, et al. (2007). A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technology Assessment, 11(14): 1–160, iii–iv.

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