When is it worth taking statins to lower high cholesterol?

People who have a high risk of cardiovascular disease are usually offered treatment using statins because the advantages for them significantly outweigh the disadvantages. This is particular true of people who

• already have a disease of the heart or the blood vessels, like coronary heart disease,
• have other risk factors like diabetes, high blood pressure or being a smoker or extremely overweight, or
• who have a family history of extremely high cholesterol levels (familial or primary hypercholesterolemia).

If you don't have an existing condition and only have a slightly increased risk of cardiovascular disease, statins will only provide a limited amount of protection. So it's particularly worth discussing the advantages and disadvantages with your doctor.

Whether or not to take statins is always a personal decision. A lot of people who have a low risk of cardiovascular disease often decide to start off by making lifestyle changes to improve their cardiovascular health. Others decide to take statins because the benefits – however small – are important to them. You can also change your mind later if, for example, new risk factors develop or your personal situation changes.

You can ask your doctor to help you assess your risk of developing cardiovascular disease. They will use a computer program based on data from long-term studies that monitored the health of thousands of people.

To calculate your risk, the program will need information about the following risk factors:

• Age: The risk of cardiovascular disease increases the older you get.
• Sex: Men are at higher risk than women.
• Family history of heart disease: The risk is higher if your brother or father had a heart attack or stroke before the age of 55 or your sister or mother before the age of 65.
• Whether you smoke
• Whether you have high blood pressure
• Whether you have type 2 diabetes
• Your cholesterol levels: High total cholesterol, high LDL cholesterol and low HDL cholesterol (“good” cholesterol) are potentially harmful.

The program then calculates your risk as a percentage showing your likelihood of having a stroke or a heart attack within the next ten years.

The two graphs below show how important it is to take all possible risk factors into account when deciding whether statins are the right option for you. They are based on the example of two women (Mary and Veronica) and two men (Peter and Yusuf).

They are all 50 years old and have the same, high cholesterol levels. But their risk of cardiovascular disease is different:

• Mary's blood pressure is slightly higher than the normal level but she doesn't have any other risk factors.
• Veronica is a smoker and her father had a heart attack at the early age of 50.
• Peter has cholesterol levels that are slightly higher than normal but no other risk factors.
• Yusuf has extremely high blood pressure and is a smoker.

The graphs show the risk of a heart attack or stroke in the next ten years for each person – with and without statins. As we can see, statins offer almost no benefit at all for Mary because she doesn't have any other risk factors. Yusuf, on the other hand, would benefit greatly because of the higher risk for men and due to his other risk factors.

By the way, the risk of a 50-year-old having a heart attack or stroke (due to natural causes) is 3% for men and less than 1% for women over the next ten years if they don't have any risk factors.

Statins are usually well tolerated. One possible, but rare, side effect is aching or tired muscles. Large-scale comparative studies over a period of five years show:

• 95 out of 1,000 people who took a placebo reported aching muscles.
• 101 out of 1,000 people who took statins reported aching muscles.

In other words, 6 out of 1,000 people who took statins for five years had aching muscles as a result of the medication.

The studies also show that muscle ache is common in people who don't take statins. But many people who do take them tend to mistakenly assume that they're the cause of their aching muscles. So it makes sense to talk to your doctor if you think your muscle ache is due to statins rather than just stopping the course of treatment right away.

In rare cases, statins can result in premature (early-onset) cataracts. Researchers found that 1 out of 1,000 people developed statin-induced cataracts within the space of a year. If this happens, it may be necessary to replace the lens of the eye with an artificial lens.

Statins can also lead to a slight increase in blood sugar levels, but this is very rare and doesn't usually have any impact on the person's health.

Since statins have a very low risk of serious side effects, experts agree that the advantages of taking them significantly outweigh any disadvantages.

Rhabdomyolysis is an extremely rare but serious side effect where the muscle tissue in certain muscles gradually breaks down. This can lead to permanent paralysis, and the breakdown products can cause kidney damage. Studies observed this side effect in about 1 out of 10,000 people over the course of a year. It is slightly more common if high doses are taken.

Rhabdomyolysis can make your muscles feel painful or quickly tired, or your urine turn a reddish or dark color. If you notice this, it's important to stop taking the statins and seek medical advice immediately.

Many people would rather not have to take medication regularly over longer periods of time. They might worry that leftover medication will build up in their body. But fears like this are unfounded: Our bodies continuously break down medications and get rid of them with the help of various mechanisms.