Statins – drugs that help lower cholesterol levels – are the most prescribed type of medication in the United States today. In fact, more than 40 million Americans are taking statins. That’s not surprising, given that high cholesterol levels are a significant contributor to heart disease, the leading cause of death in the United States.
Despite millions of people seeing good results with statins, others are reluctant to take this medication, even when their health care provider has prescribed it. Why is that? Let’s take a look at the benefits, side effects and myths associated with this important medicine.
Cholesterol 101
To understand statins and the role they play, we must first look at cholesterol. Cholesterol is a waxy substance that travels through the bloodstream. Despite the bad rap it gets, cholesterol plays an important role in our health: it helps the body make Vitamin D and certain hormones, and aids in the digestive process.
But just like with a 24-ounce ribeye steak, too much is a bad thing. Excess cholesterol – specifically, low-density lipoproteins (LDL cholesterol) – contributes to the buildup of plaque in the arteries. Too much plaque in our blood vessels results in coronary artery disease (CAD), the most common type of heart disease.
Plaque buildup also leads to atherosclerosis, the narrowing of the blood vessels. If enough plaque builds up, a blockage can result. When a blockage cuts off blood flow to the heart, a heart attack occurs. If blood flow to the brain is impeded, a stroke will result. While some people can successfully recover from these events, they remain leading causes of death and disability.
“It’s true that the food we eat impacts our cholesterol levels – that’s the reason we see cholesterol content included in food’s nutritional data, alongside things like fat, sugar and carbohydrates,” explains Dr. Mark Ziats, an internal medicine specialist in Fort Worth. “And while we should be mindful of how much cholesterol is in our food, that’s not the whole story: only about 25% of the cholesterol in our body is from food; the rest is manufactured by our liver.”
Keep in mind, our liver is supposed to produce some cholesterol to support certain bodily functions. Some people’s livers simply produce too much of it – that’s often the result of heredity and is outside anyone’s control.
That’s where statins come in.
How Statins Lower Cholesterol
Statins help lower cholesterol levels in a couple of important ways. First, they block the enzymes the liver uses to produce cholesterol. At the same time, statins help increase our high-density lipoproteins (HDL cholesterol) – this is considered the “good” cholesterol that helps transport the bad, LDL cholesterol to the liver to be expelled from the body.
People take statins via a tablet or capsule, once a day. There are several different types of statins your doctor may prescribe:
- Atorvastatin
- Fluvastatin
- Lovastatin
- Pitavastatin
- Rosuvastatin
- Simvastatin
Who Should Take a Statin?
The primary group of people who take statins are those with elevated cholesterol levels. For most people, total cholesterol levels should be under 200 milligrams per deciliter (mg/dL) and LDL cholesterol should ideally be under 100 mg/dL. People who have a history of heart disease or are at elevated risk of a heart attack may be encouraged to bring their cholesterol levels down even further.
In recent years, statins are increasingly being prescribed to patients whose cholesterol levels are in the normal range but have other risk factors for heart disease. The U.S. Preventative Services Task Force – an independent advisory group of medical professionals – recommends that adults between the ages of 40 and 75 be prescribed a statin if they have one or more risk factors for cardiovascular disease, such as hypertension, diabetes, high body-mass index or smoking.
“Statins are highly effective at reducing cholesterol levels and bringing them into normal ranges for most people and they may provide benefits to other patients who have a higher risk of heart disease,” explains Dr. Allison Collins, a family medicine physician in Fort Worth. “Statins are inexpensive and well-tolerated by most patients.”
Side Effects of Statins
Like any medication, statins may produce side effects in some people. Overall, side effects from statins are not common. When they are reported, the most common side effects are:
- Muscle aches
- Headaches
- Nausea
Clinical studies have shown that patients taking a statin reported muscle aches in similar proportions to those who were taking a placebo. In these double-blind studies, participants do not know if they are taking the real medication or a placebo (a pill that does nothing).
This could indicate that people perceive they have new muscle pain based upon some general knowledge about a possible connection to statins, or simply that muscle pains become more prevalent as people get older, for a variety of reasons.
Regardless, people taking any medication should always report side effects to their doctor.
Extremely rare, more serious side effects of statins may include:
- Increase in blood sugar levels. It’s believed statins don’t cause someone to become type 2 diabetic, but they may slightly accelerate the process if the patient was already on the path to developing type 2 diabetes.
- Liver damage
- Muscle cell damage
There are a few limitations to keep in mind when taking a statin. With certain statins, people should avoid grapefruit and grapefruit juice, as the fruit increases the level of statins in the bloodstream, which can in turn produce side effects.
Pregnant or nursing women should not take statins. People with certain types of liver disease may also be prevented from taking statins.
Statin Myths
Just like with vaccines, there is a lot of fake news out there about statins. If you search “statins” on Facebook or X (formerly Twitter), all kinds of false information pops up. Let’s look at some of the most common myths:
- Myth 1: Statins are linked to memory loss or cognitive issues. Several studies have been conducted on this topic, and the most credible and rigorous of them have not established any link between statins and memory loss.
- Myth 2: Statins cause cataracts. High-caliber, human clinical trials have not validated this concern.
- Myth 3: Statins make you diabatic. As mentioned earlier, statins may cause a slight increase in blood sugar. This does not mean, however, that taking a statin will cause someone to become diabatic. Any blood sugar increase is usually minimal.
- Myth 4: Supplements work just as well. Some believe that they can manage high cholesterol through supplements such as fish oil, garlic and turmeric. While these may provide some health benefits, they are not proven to be effective at lowering cholesterol levels.
Unfortunately, these myths are taking a toll. A 2023 study in JAMA Network Open, a publication of the American Medical Association, found that one of five high-risk patients in a population-based study of 24,000 refused to take recommended statins. This was true even when the patients had suffered a serious health event, such as a stroke. Additionally, women were about 20% more likely to refuse a statin.
A 2014 Johns Hopkins study analyzed two decades of published research on statins. This in-depth analysis concluded that the benefits of statin use far outweigh any side effects, especially for patients most at risk of cardiovascular disease.
“There is a lot of misinformation out there about statins, which is really unfortunate, as these drugs can save and prolong lives” says Dr. Brandy Yeary, a family medicine physician in Mansfield. “Don’t believe the myths; instead, consider the facts: cardiovascular disease is the number one killer in America and statins are a key weapon in our fight against heart disease.”
Statins May Be Important for Your Health
You may be one of the 40 million Americans who currently take a statin – or maybe you’re one of the millions more who should be on one due to a heart disease risk factor or elevated cholesterol levels. Make sure you are up to date on your cholesterol screenings and visit with your doctor to see what’s best for you.
And remember, whether you are taking a statin or not, a healthy diet and getting adequate physical activity remain the foundation of living a healthier, longer life.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
3 Myths About Cholesterol-Lowering Statin Drugs | Johns Hopkins Medicine
Statin side effects: Weigh the benefits and risks – Mayo Clinic
Statins: Types, Uses & Side Effects (clevelandclinic.org)
How Statin Drugs Protect the Heart | Johns Hopkins Medicine
A fifth of patients in study refused cholesterol-lowering drugs, despite benefits | WBUR News
