Doctors try to predict and prevent heart attacks by measuring blood levels of LDL cholesterol and treating you if they are too high. Statins and PSK9 inhibitors are among the most effective drugs used to lower high LDL cholesterol. Almost half of all North American adults will suffer heart and blood vessel disease (Circulation, Jan 2019;139(10):e56-e528), and statins can help to save your life by lowering LDL cholesterol and reducing inflammation. Statins can lower LDL cholesterol by 38 percent (Cardiol, Jan 2023;81(1):1–12).
More than 20 percent of patients at high risk for heart attacks refuse to take statins to lower the bad LDL cholesterol (JAMA Netw Open, March 2023;6(2):e231047). Researchers followed 24,212 patients, average age 58, who had atherosclerotic heart disease, diabetes or high LDL cholesterol levels greater than 190 mg/dL and had never taken statin drugs to lower cholesterol. Having an LDL cholesterol level greater than 100 usually puts you at significant risk for a heart attack. Those who took statins dropped their LDL cholesterol levels below 100 mg/dL in 1.5 years, compared to 4.4 years for those who did not take the statins. Patients who were prescribed statins and took them less than 70 percent of the time had a 20 percent increase in death rate compared to those who took them at least 90 percent of the time (JAMA Cardiol, 2019;4(3):206-213).
Why Some People Refuse To Take Statins
An analysis of 176 different studies including more than four million patients found that about nine percent of statin-treated patients had significant reactions when they took the drugs (Annual Congress of International Cardiology (CADECI), Guadalajara, Mexico, Feb 22, 2023). Risk factors for having side effects from taking statins include:
• being obese
• having low thyroid function
• having diabetes
• using drugs to control heart rhythm
• drinking alcohol
• exercising regularly
• having liver disease
• being in chronic kidney failure
• taking calcium channel blockers
• taking high-dose statins
Statin intolerance was not related to smoking, high blood pressure, taking anti-coagulant such as warfarin, or how long a person had taken the statins.
Muscle Pain Is The Main Concern
In one study, those who took statins were 40 percent more likely to suffer muscle pain than those who took no medication, but there was no control group to see how this compared to people taking placebos. When subjects were compared to those who took placebos, only two percent were more likely to suffer pain than people who took placebos (Lancet, Jun 24, 2017;389(10088):2473-2481). Another study (the STOMP study) found that nine percent of patients taking a statin developed muscle pain, compared to four percent of those taking placebos (Circulation, 2013;127(1):96-103). The GAUSS-3 study found that almost all patients taking statins suffered some discomfort, compared to 60 percent taking placebos (JAMA, Apr 19, 2016;315(15):a580-1590).
More serious side effects from taking statins are extremely rare. They include:
• liver damage
• kidney failure
• increased blood sugar
• nerve damage
• life-threatening muscle damage called rhabdomyolysis, which can cause severe muscle pain
Should You Take Statins?
Current recommendations are that most people with LDL cholesterol greater than 100 should take statins when they have other heart attack risk factors. Talk to your doctor. Don’t start an exercise program at the same time you start taking statins, since exercisers are at significantly increased risk for suffering muscle pain from statins.
Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor, FloLipid).