Don't be afraid of statins

Statins can help people lower their risk of heart attack and stroke, yet many resist them.

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Statins have been doing what they do — lowering cholesterol to help prevent cardiovascular disease — for more than three decades. Still, many people who could benefit from the drug don't take it.

"Statins have a role in people's health under the right circumstances," says Dr. Randall Zusman, director of the Division of Hypertension at the Harvard-affiliated Massachusetts General Hospital Heart Center. "Yet, people who can benefit from statin therapy sometimes avoid it because they misunderstand how the drug works, including the nature and frequency of side effects, as well as the larger role statin therapy can take in managing their longer-term health."

The role of statins

Statins work to lower the production of low-density lipoproteins (LDL), or "bad" cholesterol, by blocking an enzyme in the liver that helps make cholesterol. 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. Also, statins 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 also can benefit otherwise healthy people with 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. (You assess your estimated 10-year risk at: /ascvd.)

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, smoking, or high blood pressure.

The fear factors

Many people avoid statins because they fear possible side effects, says Dr. Zusman. "They are scared by what they hear from friends and read from Dr. Google." The most common side effect is achy muscles, and some people report feeling less energetic, weak, or tired, all of which may cause them to exercise less or at lower intensity. Yet, studies have shown that most often these side effects are not actually caused by the statin.

One rare, but potentially serious, side effect of statins is widespread muscle damage causing 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.

Still, most side effects are minimal and potential harm from low- to moderate-dose statins is small. "Also, not all statins have the same frequency of toxicities," says Dr. Zusman. "A person can often take one statin when he or she might not have been able to tolerate another."

Statins may lower risk of Alzheimer's

A study published Dec. 12, 2016, in JAMA Neurology looked at 400,000 Medicare beneficiaries who used statins and found that the men in the group who took statins on a regular basis for two years or longer had a 12% lower risk of getting Alzheimer's. This only showed an association, but the researchers suggested that statins may reduce buildup of beta-amyloid plaques in the brain that interfere with memory.

Try lifestyle changes

If you're still uncertain about taking a statin and your doctor has recommended it only for a high cholesterol level, you can first try to lower the level through lifestyle changes.

For example, a Mediterranean-style diet (which emphasizes fish, whole fruits and vegetables, and healthy oils) combined with regular exercise can help lower LDL cholesterol levels. In some people who stick with the program, the drop in LDL can be impressive.

"Try this approach for three to six months, but if there isn't a significant change in your levels, you need to talk with your doctor about beginning statin therapy," says Dr. Zusman. However, be mindful that very high cholesterol may be hereditary, meaning you'll need statins to keep it under control even with lifestyle modifications.

The best way to view statins — and any potential resistance to taking them — is how they can help you now and going forward. "Speak with your doctor about your heart attack and stroke risk — whether it is low, medium, and high — and then discuss all their treatment options," says Dr. Zusman. "For most people, the benefits outweigh any possible downside."

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