Statins: Are these cholesterol-lowering drugs right for you?
Find out whether your risk factors for heart disease make you a good candidate for statin therapy.
Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol.
Lowering cholesterol isn’t the only benefit associated with statins. These medications have also been linked to a lower risk of heart disease and stroke. These drugs may help stabilize the plaques on blood vessel walls and reduce the risk of certain blood clots.
A number of statins are available for use in the United States. They include:
- Atorvastatin (Lipitor)
- Lovastatin (Altoprev)
- Pitavastatin (Livalo, Zypitamag)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor, Ezallor)
- Simvastatin (Zocor)
Sometimes, a statin is combined with another heart medication. Examples are atorvastatin-amlodipine (Caduet) and ezetimibe-simvastatin (Vytorin).
Should you be on a statin?
Whether you need to be on a statin depends on your cholesterol levels and other risk factors for heart and blood vessel (cardiovascular) disease. Your doctor will consider all of your risk factors for heart attacks and strokes before prescribing a statin.
Knowing your cholesterol numbers is a good place to start.
- Total cholesterol. Most people should try to keep their total cholesterol below 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L).
- Low-density lipoprotein (LDL) cholesterol. Aim to keep this “bad” cholesterol under 100 mg/dL, or 2.6 mmol/L. If you have a history of heart attacks or you’re at a very high risk of a heart attack or stroke, you may need to aim even lower (below 70 mg/dL, or 1.8 mmol/L).
The most important thing your doctor will keep in mind when thinking about statin treatment is your long-term risk of a heart attack or stroke. If your risk is very low, you probably won’t need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L).
If your risk is very high — for example, you’ve had a heart attack in the past — a statin may be helpful even if you don’t have high cholesterol.
Besides cholesterol, other risk factors for heart disease and stroke are:
- Tobacco use
- Lack of exercise
- High blood pressure
- Overweight or obesity
- Narrowed arteries in your neck, arms or legs (peripheral artery disease)
- Family history of heart disease, especially if it was before the age of 55 in male relatives or before 65 in female relatives
- Older age
Risk assessment tools
Your doctor may use an online tool or calculator to better understand your long-term risks of developing heart disease and whether a statin may be right for you. These tools can help your doctor predict your chances of having a heart attack in the next 10 to 30 years. The formulas in these tools often consider your cholesterol levels, age, race, sex, smoking habits and health conditions.
Not everyone with a heart condition needs to use a statin. Guidelines from the U.S. Preventive Services Task Force, American College of Cardiology and American Heart Association suggest four main groups of people who may be helped by statins:
- People who don’t have heart or blood vessel disease, but have one or more cardiovascular disease risk factors and a higher 10-year risk of a heart attack. This group includes people who have diabetes, high cholesterol or high blood pressure, or who smoke and whose 10-year risk of a heart attack is 10% or higher.
- People who already have cardiovascular disease related to hardening of the arteries. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, ministrokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.
- People who have very high LDL (“bad”) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.92 mmol/L) or higher.
- People who have diabetes. This group includes adults 40 to 75 who have diabetes and an LDL cholesterol level between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of blood vessel disease or other risk factors for heart disease such as high blood pressure or smoking.
The U.S. Preventive Services Task Force recommends low- to moderate-dose statins in adults ages 40 to 75 who have one or more risk factors for heart and blood vessel disease and at least a 1 in 10 chance of having a cardiosvascular disease event in the next 10 years.
Healthy lifestyle is still key for preventing heart disease
Lifestyle changes are key for reducing your risk of heart disease, whether you take a statin or not. To reduce your risk:
- Quit smoking and avoid secondhand smoke
- Eat a healthy diet rich in vegetables, fruits, fish and whole grains and low in saturated fat, trans fat, refined carbohydrates and salt
- Be physically active more often and sit less
- Maintain a healthy weight
If your cholesterol — particularly the LDL (“bad”) type — stays high after you make healthy lifestyle changes, statins might be an option for you.
Consider statins a lifelong commitment
You may think that if your cholesterol goes down, you don’t need a statin anymore. But if the drug helped lower your cholesterol, you’ll likely need to stay on it long term to keep your cholesterol down. If you make significant changes to your diet or lose a lot of weight, talk to your doctor about whether it might be possible to control your cholesterol without medication.
Side effects of statins
Statins are tolerated well by most people, but they can have side effects. Some side effects go away as the body adjusts to the medication.
But tell your doctor about any unusual signs or symp