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Addressing fear around statins

Last Modified: April 07, 2021

Family Medicine, Heart Health


This post was written by Madhavi Chilakamarri, MD, PPG – Family Medicine and Internal Medicine.

Statins are medications prescribed to help a patient lower their low-density lipoprotein (LDL) cholesterol, often thought of as the “bad cholesterol.” While these can be incredibly beneficial, some patients have reservations about statins. The best way to view statins and any fear of taking this important medication is understanding how they can help you now and going forward in preventing major heart attacks and devastating strokes.

People often fear statins for three main reasons:

  • Because of their perceived side effects
  • Due to a misunderstanding of how they work
  • They underestimate the risk of not taking them when necessary
Side effects

Much of the fear surrounding statin side effects comes from bad information online and/or stories shared by friends. In truth, the most common side effect is achy muscles, and in some cases, less energy or fatigue. However, studies have shown that these side effects are not actually caused by the statin in most cases.

One rare, but potentially serious side effect of statins is widespread muscle damage called Rhabdomyolysis caused by high levels of a muscle enzyme that can lead to kidney injury. The symptoms are pain in various muscles, weakness and dark urine. If this occurs, stop taking the drug and call your doctor immediately.

Overall most side effects are minimal and potential harm from low- to moderate-dose statins is small. It is important to also remember that not all statins have the same frequency of side effects. There are many different statins. You might be able to tolerate one better than another, so it’s worth giving different statins a try.

The benefits of statins

Statins work by inhibiting a liver enzyme that reduces the bad cholesterol or LDL cholesterol. Most of the side effects are related to this enzyme inhibition, however, this enzyme inhibition is reversible if the patient has to discontinue the medicine for any reason. Why is too much LDL a bad thing? High LDL levels can create plaque buildup in the arteries, which can block blood flow and raise your risk of a heart attack or stroke.

But the benefits of statins go beyond just lowering LDL cholesterol. Statins have anti-inflammatory properties, and inflammation is a known contributor to plaque buildup. Statins also help prevent plaques from breaking open and releasing chemicals that stimulate blood clot formation, which is the cause of most heart attacks.

Who needs statins?

Anyone who has coronary artery disease or other arterial disease caused by plaque buildup should be on a statin, even if the person has a normal cholesterol profile. Statins can also benefit otherwise healthy people who have elevated LDL cholesterol levels of 160 milligrams per deciliter (mg/dL) or higher, and those with a 10-year risk of cardiovascular disease at 7.5% or higher.

Even people with a lower LDL cholesterol level — for example, 100 mg/dL — should consider taking a statin if they have other risk factors, such as diabetes, a family history of heart disease before age 55, a history of smoking or high blood pressure.

You should speak with your doctor about your risk of heart attack and stroke and the role of statins in prevention. For most people, the benefits outweigh any possible serious side effects.

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