You might be familiar with statins. More than one in four Americans over 40 take these cholesterol-lowering drugs, for good reason: By reducing blockage in blood vessels, statins reduce the chances of cardiovascular disease (better known as heart disease) and strokes.
“Heart disease is the number one killer in this country,” explains Dr. Douglas S. Jacoby, Medical Director at the Penn Medicine Center for Preventative Cardiology and Lipid Management. “Studies continue to point to statins for preventing heart attacks as well as strokes. There’s rarely a situation where someone who’s at-risk shouldn’t consider them.”
Since being approved in the United States in 1987, statins have been prescribed to tens of millions of at-risk patients – and are believed to have prevented millions of heart attacks and strokes. For all of their proven benefits, though, they’re still the subject of misconceptions that lead some people to wonder, Are statins worth it?
Before we get to that question, let’s take a look at how statins work.
What Are Statins and How Do Statins Work?
Most people associate statins with the heart, but these cholesterol-lowering (also known as lipid-lowering) drugs actually work in the liver.
“The liver is responsible for the vast majority of cholesterol production in the body,” Dr. Jacoby explains. “Statins are inhibitors that block the function of the liver enzyme HMG-CoA reductase, which is essential to cholesterol formation.”
Statins can stabilize cholesterol plaque already attached to artery walls, making it less likely to get worse or rupture, causing a heart attack or stroke.
"Statins also help remove cholesterol from you blood by causing the liver to express more LDL cholesterol receptors that take cholesterol out of your blood," Dr. Jacoby explains.
Who Should Take Statins?
Broadly speaking, statins are a fit for two groups of people.
“Statins are recommended for people who have been diagnosed with heart disease, who have had a heart attack or stroke, have a stent, or who are known to have plaque in their body,” Dr. Jacoby explains.
For a second group, statins intervene earlier, fending off potential health issues before they start.
“Statins are also recommended for people known to be high-risk based on other conditions, like a genetic predisposition to high cholesterol or heart disease, or diabetes. Sometimes multiple smaller risk factors lead to a prescription, like someone who is overweight and also has rheumatoid arthritis or psoriasis. Conditions that cause inflammation can contribute to the risk of heart attack.”
The genetic predisposition detail is an important one, Dr. Jacoby says. He encourages everyone to take a close look at their family tree.
“Most people with a family history of heart disease would benefit from a visit with a provider that has an expertise in prevention. Traditional risk guidelines don’t factor in family history, but once you do, it’s not uncommon to find that someone initially considered low risk actually is at risk.”
Side Effects of Statins: Risk Versus Benefit
Like all drugs, statins bring the risk of side effects. Muscle pain, liver damage, increased blood sugar, and fuzzy thinking are the most common – which can scare some candidates off. But as Dr. Jacoby points out, these side effects can be eliminated through trial and error and are 100% reversible.
“I would never encourage a patient to continue preventative medicine if they’re experiencing a side effect. With statins, luckily, they rarely have to. For some, eliminating muscle pain is as simple as increasing vitamin D intake. For others, we vary dosage and move between different statin brands until we find the best fit. Different statins are metabolized by different liver enzymes, so they interact differently with the body.”
Dr. Jacoby emphasizes that the rumored connection between statins and permanent memory loss is false.
“Concerns about dementia are not valid at this point,” he says. “A very small percentage of patients note decreased cognition while taking statins, but it’s important to note that it is reversible. If you notice a difference in your thinking, you can simply take a break from the drug, recover, and consider another statin. Sometimes it means trying four or five statins until finding one that can be tolerated without side effects.”
In other words, work patiently and closely with your doctor, and odds are high that you’ll find a statin that’s not only side effect-free, but that might just save your life.