Statins: Good or Bad?

People with heart failure often have additional comorbidities, such as elevated cholesterol levels. Elevated cholesterol is also known as hypercholesterolemia in the medical world. The most common treatment for high cholesterol is the use of a certain class of medications commonly known as statins. Are statins safe, and how well do they really work?

What are statins?

Statins are in a class of medications known as hydroxymethylglutaryl (HMG) CoA reductase inhibitors.¹ They work by blocking the production of cholesterol. It is easy to differentiate these drugs by their generic names, which end in “-statin”. Examples of the most commonly-prescribed statins include:

• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

How safe are they?

Despite their bad reputation, statins have fewer side effects than most other drugs used to lower cholesterol.² Overall, Statins are effective and safe.

When people are concerned about statin side effects, they are typically referring to the liver and muscle adverse effects:

• Liver harms – the actual risk of potential harm to the liver is 0.5-3%. This usually occurs in the first 3 months of drug therapy, and is more likely to occur if you were prescribed a high dose initially.³
• Muscle pain - there are various risk factors that increase the risk of muscle injury. For example, people with certain conditions such as kidney dysfunction, low thyroid levels, or myasthenia gravis, are at a higher risk.⁴ People on certain medications may also have a higher risk due to drug interactions. However, this risk is overall very low. Muscle pain can occur anywhere between 2-11% of people who take statins (and is completely reversible), but severe muscle injury is extremely rare at 0.1-0.5%.⁵

If a statin is discontinued due to side effects, most people can tolerate another statin or a dose reduction.

Do I absolutely need a statin?

Not everyone with high cholesterol needs a statin. The goal of statin therapy is to reduce the risk of heart attacks and stroke.

A decision to initiate a statin really depends on your other risk factors; for example, people who smoke and have high blood pressure are at a higher risk of heart attacks and stroke. Some of these factors are modifiable, in which your physician will inform you of the lifestyle modifications you need to make. Some lifestyle modifications include:⁶

• Reducing intake of animal products, such as red meat
• Exercise
• Weight loss, if necessary

For other people, a statin is recommended because lifestyle changes may not create the level of improvement needed in cholesterol levels. For example, the following people have been shown to benefit from statin use:^7-8

• People with a history of a heart attack or stroke
• Those with diabetes
• People with peripheral artery disease

Typically for these people, a statin is initiated and continued indefinitely.

I commonly see people feeling disappointed when they hand in a new prescription for a statin. I want to stress that starting statin therapy does not mean you have failed in your health journey. Some people do everything right: they eat healthily and exercise on a regular basis, but continue to have elevated cholesterol levels.