One of the most common topics we discuss in our practice is the use of statins—their risks, benefits, why they are prescribed, and when they are appropriate. There is a large amount of information circulating through social media, magazines, and other outlets. While some of it is scientifically accurate, much of it is opinion-based or simply incorrect.
We welcome questions—all questions. We firmly believe that the more patients understand their conditions and treatments, the better equipped they are to make informed, confident decisions about their health.
How We Decide When a Statin Is Appropriate
Statins are generally very safe medications when used appropriately and at the correct dose for each individual.
For over a decade, decisions about starting a statin for primary prevention (preventing a first cardiovascular event) have been guided by validated cardiovascular risk calculators. These tools consider:
- Age, sex, and race
- Total cholesterol and HDL
- Blood pressure
- History of hypertension, diabetes, or tobacco use
- Family history
If a patient’s 10-year cardiovascular risk is 10% or higher, we typically begin a discussion about starting a statin.
There are also groups where statin therapy is recommended regardless of calculated risk, including patients with:
- Diabetes
- Coronary artery disease
- Peripheral artery disease
- Prior heart attack
- Prior stroke or TIA
What Statins Do
Statins work by inhibiting an enzyme in the liver (HMG-CoA reductase), which reduces cholesterol production. In addition to lowering LDL (“bad” cholesterol), they also help stabilize plaque in the arteries and reduce inflammation—both key factors in preventing heart attacks and strokes.
Proven Benefits
Extensive clinical trials and meta-analyses have consistently shown:
- Reduced risk of heart attack, stroke, and cardiovascular death. Each significant reduction in LDL cholesterol lowers major cardiovascular events by approximately 20–25%.
- Improved survival in higher-risk patients, particularly in those with established cardiovascular disease.
- Plaque stabilization and anti-inflammatory effects, helping prevent plaque rupture, a major cause of acute cardiac events.
Known Risks
Like all medications, statins do carry potential risks, though serious complications are uncommon:
Muscle symptoms
Occur in a small percentage of patients; severe muscle injury is rare.
Mild liver enzyme elevations
Typically not clinically significant and rarely lead to serious liver issues.
Slight increase in diabetes risk
Primarily in patients already at risk; the cardiovascular benefits generally outweigh this risk.
Common Misconceptions
High-quality research has not shown a causal link between statins and:
- Dementia or memory loss
- Cancer
- Kidney failure
- Many reported side effects in real-world settings are influenced by the nocebo effect, where expectations of harm contribute to perceived symptoms.
Putting It All Together
In patients with known cardiovascular disease, the benefits of statins clearly outweigh the risks.
In primary prevention, the decision depends on overall cardiovascular risk—not cholesterol numbers alone.
Treatment should always be individualized and discussed with your healthcare provider.
Final Thoughts
Statins are not simply “cholesterol medications”—they are powerful tools for reducing cardiovascular risk and preventing life-threatening events.
If you have questions about statins or any other aspect of your care, we encourage you to ask. Our goal is to provide clear, evidence-based guidance so we can make the best decisions together.
If there are other topics you would like us to cover, please let us know.
God bless you all.
Gary M. Fowler, MD
