Despite the discussions on social media, statins are a safe and effective medication option for lowering “bad” cholesterol. Statins reduce the risk of heart events.
A doctor I know well once told me something really important about medications: “There is no free lunch in pharmacology.” He meant that no matter what amazing thing a drug might do for us, nothing is ever without side effects. And that’s true of most things. There are certain groups of drugs where the benefits, such as reducing the risk of death from a heart attack, often outweigh side effects. But that decision is an individual decision. There’s a lot of fear-mongering on social media about different classes of medications and their side effects. So it’s important to talk to your clinician about concerns you might have about taking a specific medication. Often, the side effects discussed on social media might not give you the whole picture and sometimes there are alternative types of medications that your clinician can recommend if you’re worried about side effects. That’s why working in partnership with a clinician you trust is so important. So let’s talk about a medication that has become extremely controversial on social media: statins.
➡️ What is a statin?
A statin is a group of drugs, also called a HMG-CoA reductase inhibitor (more on this soon!) that work to lower lipid levels in your body and decrease your risk for heart disease. Lipids are a group of molecules that include cholesterol, fatty acids, and triglycerides. All of those molecules have important functions in your body but too much can cause problems. Scientists have looked at a bunch of studies over time and crunched the numbers and their reviews have shown that statins help stave off heart disease and reduce the risk of death from heart disease in those at higher risk. Statins work by stopping the protein in your body that makes cholesterol.
🤓 Nerd Alert!: How exactly do they do all that? HMG-CoA reductase is an enzyme. Enzymes make chemical reactions in your body go faster. HMG-CoA reductase lives in the cells of your liver and converts a molecule called HMG-CoA into another molecule called mevalonate. This process is the first step your body takes to make cholesterol. Statins work to stop that enzyme, which decreases the amount of cholesterol that your body makes.
So what is cholesterol and why is it so bad? There are a few different types of cholesterol. We’ll focus on LDL and HDL, which are commonly known as “good” and “bad” cholesterol.
- LDL, or bad cholesterol, moves around in the blood and goes from the liver to the rest of your body, and sometimes drops cholesterol off where it isn’t needed. When LDL drops off too much cholesterol to your body, it can build up in arteries and veins, which we’ll talk about below.
- HDL, good cholesterol, takes cholesterol from the body and brings it back to the liver so you can get rid of what you don’t need.
Your body needs some cholesterol because it’s an important building block for things like cell membranes and certain hormones. But when the levels of cholesterol increase far beyond what our bodies need, it can start building up in our organs and vessels. Cholesterol build-up, especially in blood vessels, is part of the creation of plaques. Plaques can ultimately make it hard for blood to get past. In certain circumstances, those plaques can break open and cause clots, which is bad because it blocks blood flow, which can cause problems like heart attacks and strokes.
Overall, statins help stabilize any existing cholesterol plaques and they help reduce inflammation, which ultimately helps decrease the risk of cardiovascular problems.
➡️ Why is my clinician telling me I need to take a statin?
The United States Preventive Services Taskforce and the American College of Cardiology have guidelines for when people should start statins. If you fall into one of these categories, your clinician will likely recommend a statin:
- LDL cholesterol, aka bad cholesterol, is 190 mg/dL or higher
- Aged 40-75 and have diabetes
- Aged 40-75 with a risk factor such as hypertension, dyslipidemia, smoking, and a 10-year atherosclerotic cardiovascular disease risk of more than 10%
For those over 75, or under 40, statins might also be recommended in certain situations.
Your atherosclerotic cardiovascular disease risk is a formula that indicates your 10-year risk of having a cardiovascular problem like a heart attack or a stroke. The formula takes information like your age, sex, race, blood pressure measurements, LDL and HDL cholesterol measurements, history of diabetes, and whether you smoke or not.
⚖️ Health Equity Alert:
A 2023 study published in Nature looked at data from 2005 to 2018 to try to determine if there was a link between socioeconomic status and cardiovascular disease risk. Their study determined that lower income was associated with an increased risk of conditions like hypertension and an increased risk of cardiac death, even when controlling for other factors like age and race/ethnicity. Research also suggests that Black and Hispanic Americans are less likely to be prescribed statins, even when their risk of cardiovascular disease is high.
➡️ Do statins have side effects?
Statins are one of the first-line medicines for decreasing cholesterol and preventing heart disease. Research shows they are excellent at doing that. Studies and meta-analyses on statins have been done extensively over the last few decades. Many of these reviews have shown that statins reduce death due to heart problems.
So why are people on social media talking about statins being bad? Some people discuss the side effects as a reason to not take statins. The side effects are real and discussed below, but some people are unfortunately not telling the truth about the benefits of cholesterol-lowering medications. Some people say statins cause dementia. A large review of the research was published this year and shows that statins actually reduce the risk of dementia. Some people say that all you need to prevent cardiovascular disease is lifestyle changes. Though lifestyle changes such as exercise and eating a diet high in fruits and vegetables is very helpful for lowering your cholesterol, some people have hereditary conditions where your body creates extra cholesterol, regardless of diet. When needed, these medications can really help!
Any medication, from an over-the-counter pain reliever, all the way to chemotherapy, has potential side effects. Statins are no different. The common side effects include:
- Muscle pain: If you’re going to get muscle pains with statin use, it will generally occur within a few weeks of starting the medication. If you start to have muscle pain, talk to your clinician. They may lower your dose, suggest you switch to a different statin or even prescribe a different cholesterol-lowering medication.
- Increased liver enzymes and kidney problems: if you show any signs of these side effects in your regular lab work, your clinician will talk to you about changing the type of statin or switching to another lipid-lowering medication.
Though there might be noise on social media about statins being bad, there are overall more benefits than risks to taking a statin if necessary.
➡️ Can I decline a statin?
If your clinician suggests that you should start taking a statin, you can say no. However, it’s important to discuss your options. A heart-healthy lifestyle is important for everyone. If your cholesterol is only mildly raised, your clinician might recommend starting only with lifestyle changes like avoiding fried and fatty foods and exercising. But sometimes, cholesterol levels stay high despite lifestyle changes. There are other types of cholesterol-lowering medications such as drugs that inhibit cholesterol absorption or another group of medications called fenofibrates. Each class of medications have different pros and cons.
Further reading:
Clinical Summary of the United States Preventive Services Taskforce Recommendations
