If you have high cholesterol, your doctor may prescribe a statin. These medications work by blocking your liver from getting the enzyme it needs to make cholesterol. When this waxy, fat-like substance builds up in your arteries, it narrows them and makes it harder for blood to flow. By lowering levels of “bad cholesterol — sometimes by as much as 50% — statins can also make you less likely to have a heart attack or a stroke.
Statins are the most commonly prescribed medications for managing high cholesterol, but it’s normal to have questions about their safety — especially with so much information and misinformation online. Gary Balady, MD, the director of preventive cardiology at Boston Medical Center, explains what the research actually says about the side effects and how to talk to your doctor about whether they’re right for you.
Q: Why are some people hesitant about taking statins?
A: Some people are hesitant to take medications at all. I have many patients who say, ‘I don't like taking pills.’ But I don't know anybody who likes taking pills, so it's actually a fairly common issue.
When it comes to statins, sometimes individuals might have read online or heard somewhere that these medications have side effects and that makes them concerned about taking them.
If you read about any medication, there’s always going to be a list of potential side effects. A side effect gets listed if more than 3% of participants report it during clinical trials, even though it may not necessarily be caused by the medication itself. When you look at a lot of different medications, many of the side effects that get reported don’t occur more often than they do with a placebo, or even in people who aren’t taking medication at all. So that's important to understand.
Q: Are the side effects really that bad?
A: When used as prescribed, statins are, for the most part, very safe and don't cause any problems. The most common side effect is muscle aches and weakness. In clinical trials, about 3% of individuals reported this issue compared with about 10% in post-marketing data. Typically, it's not dangerous unless the muscle side effects are very, very severe. But that is extremely rare.
In about half of patients who do have muscle side effects, when taken off the medication and then put back on it, the muscle aches stop. We can also try a different statin and they may not experience that side effect at all.
Q: Are some people more likely to have side effects than others?
A: People are more likely to experience muscle side effects if a statin is taken in combination with certain medications, including macrolide antibiotics, HIV medication, and fibrates. Your provider will check for potential drug interactions before writing you a prescription.
Q: What about the more serious side effects that show up online?
A: Those are extremely rare. Liver abnormalities are one example, and they are more likely in people who have underlying liver disease. Diabetes is another. The reported incidence of glucose intolerance is about 5 in 1,000 individuals. All the guidelines say that the risk of high cholesterol outweighs the risk of developing diabetes.
I also have to reassure my patients all the time that there are no cognitive deficits associated with statins. Preventing vascular disease and vascular problems with statins can actually help prevent dementia or mitigate the progression of dementia.
Q: What should I do If I experience side effects?
A: The first thing you should do is reach out to your provider and describe what the side effect is and when it occurred so they can help you figure out whether it’s likely due to your medication or not.
If you’re experiencing muscle pain for a few weeks, your doctor might recommend stopping the medication for a while and then retrying it. If you have the same side effects once you start taking it again, we can try another statin and maybe also start on a lower dose.
Q: What happens if you don’t take statins?
A: Statins are among the most effective medications that we have in preventive cardiology today and are largely responsible for the reduction in heart attacks that we're seeing across the board here in the United States. On average, they reduce your risk of having a heart attack or stroke by around 25% to 35%.
Q: Are statins overprescribed?
A: The data actually shows that people who want statin therapy are often not receiving it, so they tend to be more underprescribed than overprescribed.
Medication adherence is one of the bigger issues. It is not uncommon for people to take the pill once and get a symptom like a headache, assume it was caused by the medication, then stop taking it — even when it’s probably not related at all. It's important to discuss those concerns with your doctor so that we can review them and steer you toward correct information.
Q: Can I fix my high cholesterol levels with diet and exercise instead?
A: Every patient is different. We assess risk factors that might increase your future chances of having a cardiovascular event, including stroke.
The American Heart Association now uses a tool called the PREVENT calculator, which estimates a patient’s 10- and 30-year risk of having a cardiovascular event. That score helps us evaluate whether or not cholesterol medication is appropriate. If the 10-year risk is over 5%, we generally recommend statins. If it’s 3% to 5%, we can discuss other ways to reduce the risk without necessarily adding medication to their regimen. If your score is less than 3%, you're considered at low risk.
A lot of cholesterol issues are genetic. Diet can help, especially if someone is consuming a lot of saturated fats. But diet on its own is typically not going to lower cholesterol enough — particularly in individuals who were trying to reduce it significantly or in those who have had a previous cardiovascular event.
Q: How do I talk about my concerns about statins with my doctor?
Never hesitate to reach out to your provider and have an open discussion about your concerns. If you have reservations against taking medications, it's important to bring that up. Your provider can help explain the reasons you could benefit from a statin.
It can also be helpful to review your current cholesterol levels and set a goal with your provider. There are certain targets that we have in certain individuals, but not everybody has the same goal.
If you decide to try a statin, ask your provider about which medication they’re prescribing, how often you should take it, and the best time of the day to take it.
