When is it worth taking statins to lower high cholesterol?

Photo of a woman reading a package insert (PantherMedia / Diego Cervo)

High cholesterol levels could mean an increased risk of cardiovascular disease. Certain medications called statins lower the amount of cholesterol in the blood. They can prevent related medical conditions and increase life expectancy. Whether or not it's worth taking them will depend on what other risk factors you have, though.

If the risk of cardiovascular disease can't be reduced enough through general measures, treatment with medication can be considered. Whether treatment with medication is a good idea will mostly depend on individual risk factors and how you yourself view the pros and cons of the treatment.

The main factor is whether you have already had cardiovascular disease, such as coronary artery disease. That may greatly increase the risk of a heart attack or stroke. This risk can be reduced using medication.

When deciding whether or not to have a certain treatment, it can help to find out about the advantages and disadvantages of the treatment. Various groups of drugs can be used for the treatment of high cholesterol. But only one group of drugs, known as statins, has been well studied in people who have never had a heart attack, stroke or other type of cardiovascular disease. Many different statins have been approved in Germany, including atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin.

Benefits of taking statins and individual risk of cardiovascular disease

The health impact of lowering cholesterol levels with statins will very much depend on your individual risk of cardiovascular disease. A doctor can help you determine your own risk.

The following table might make it clearer why other risk factors have to be considered too. It describes two men and two women who are at “low” or “high” risk of cardiovascular disease. “Low risk” means they have high cholesterol levels only. "High risk" means that, in addition to having high cholesterol levels, they have other risk factors such as smoking, high blood pressure or diabetes.

The number in the first column indicates how many out of 100 people will have a heart attack or stroke within the next ten years if they don't take statins. The number in the second column indicates how many people will have one of these cardiovascular events within the next ten years if they take statins during that time. The third column shows the difference between the two groups – in other words, the number of people that statins will prevent heart attacks or strokes in.

Table: Risk of having a heart attack or stroke within the next ten years
  Without statins With statins Heart attack
or stroke prevented in
Woman - low risk 4 out of 100 3 out of 100 1 out of 100
Woman - high risk 18 out of 100 13 out of 100 5 out of 100
Man - low risk 11 out of 100 8 out of 100 3 out of 100
Man - high risk 33 out of 100 23 out of 100 10 out of 100

The table makes it clearer that women and men who have a higher risk of cardiovascular disease benefit more from statins than those who have a low risk. In other words, the higher your risk of cardiovascular disease, the more likely you are to benefit from taking statins. But it isn't possible to predict who will benefit from the treatment and who will not.

What are the side effects of statins?

Statins are usually well tolerated. But a few studies suggest that there is a small group of people who react more sensitively to these drugs, and who may get muscle pain when they use them.

Statins can also lead to an increase in blood sugar levels. In studies, statins were found to lead to high blood sugar levels in 1 out of 1,000 people per year. But it's not clear whether this affects their health.

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 serious kidney damage. In studies, rhabdomyolysis was found to occur in 1 out of 10,000 people who took statins for longer periods of time. Signs of rhabdomyolysis include muscle pain and dark-colored urine. So it's important to seek medical advice if you have these symptoms.

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.