Do I need statins for high cholesterol?

Being told that you might need a statin can feel like a big step, especially when you feel completely well.

You may wonder why you need daily medication for something that is not causing symptoms. Perhaps you would rather try changing your diet or becoming more active first. You might also be worried about side effects or what happens once treatment begins.

These are reasonable questions. The decision is not based on a high cholesterol result alone. What matters is whether lowering your cholesterol is likely to reduce your chance of having a heart attack or stroke in the future.

When are statins recommended?

Statins may be recommended when your overall chance of developing heart and circulatory disease is high enough for treatment to provide a meaningful benefit.

A clinician will consider factors including:

• Your age
• Your blood pressure
• Whether you smoke
• Whether you have diabetes
• Your medical history
• Your cholesterol levels

In the UK, a tool called QRISK is commonly used to estimate your chance of having a heart attack or stroke within the next ten years.

This gives a more useful picture than looking at cholesterol alone. Two people can have a similar cholesterol result but different levels of cardiovascular risk because of differences in their wider health.

Statins may also be recommended if you already have heart or circulatory disease, or if your cholesterol is particularly high because of an inherited condition.

How do statins protect me from a heart attack or stroke?

Statins reduce the amount of cholesterol produced by the liver, particularly low-density lipoprotein, or LDL cholesterol.

When LDL levels are high, cholesterol can build up within the artery walls and contribute to the formation of fatty deposits called plaques. Over time, these plaques can narrow the arteries.

A plaque can also become unstable and rupture. This may trigger a blood clot that blocks an artery and causes a heart attack or stroke.

Statins lower LDL cholesterol and help stabilise plaques, making them less likely to rupture. Their purpose is therefore not simply to improve a blood test result. They are used to reduce the likelihood of a serious cardiovascular event in the future.

Can I try lifestyle changes before taking statins?

Lifestyle changes are an important part of protecting your heart, whether or not you take medication.

Improving your diet, staying physically active, maintaining a healthy weight and avoiding smoking can all help lower your overall cardiovascular risk.

For someone whose risk is relatively low, these changes may be enough without medication. Your clinician may suggest making sustainable changes and then reviewing your cholesterol and wider health.

If your risk is higher, lifestyle changes may not reduce it enough on their own. A statin may then be recommended alongside them to provide a greater and more reliable reduction in your chance of heart disease or stroke.

Taking a statin does not mean that lifestyle changes no longer matter. The two approaches work together rather than replacing one another.

Are statins safe, and what if I develop side effects?

Statins have been widely used and studied over many years. Most people take them without significant problems.

Possible side effects can include:

• Muscle aches
• Headaches
• Digestive symptoms
• Changes in sleep

These effects are often mild. Some improve as your body adjusts to treatment, while others may settle after the dose or type of statin is changed.

Serious muscle injury or liver problems can occur, but they are uncommon.

Do not assume that you have to choose between tolerating difficult symptoms and stopping treatment completely. If you think a statin is causing side effects, speak to your doctor. Adjusting the dose, trying another statin or considering a different treatment may help.

Will I need to take a statin for the rest of my life?

Statins do not permanently remove the tendency for your cholesterol to be raised. They keep cholesterol under better control while you continue taking them.

If treatment is stopped, cholesterol levels will usually rise again over time. This may also reduce the protection the medicine was providing against heart attack and stroke.

For this reason, statins are often used as a long-term treatment. That does not mean the decision can never be revisited.

Your treatment should be reviewed periodically to make sure it remains appropriate for your health, cardiovascular risk and preferences. Do not stop taking a statin without discussing it with your doctor and agreeing on what should happen next.

Could I need statins even if I am relatively young?

Statins are not only prescribed to older people.

Age contributes to cardiovascular risk, but it is not the only factor. Treatment may be considered earlier if you have:

• Particularly high cholesterol
• Diabetes
• A strong family history of heart disease
• An inherited condition that raises cholesterol

Familial hypercholesterolaemia can cause cholesterol levels to be significantly raised from a young age. People with this condition may need earlier treatment because they are exposed to high cholesterol over a much longer period.

The decision should still be based on your individual circumstances rather than age alone.

How can I decide whether taking a statin is right for me?

Speak to your doctor if you have been advised to take a statin but remain unsure about the recommendation.

It may help to ask:

• What is my estimated chance of having a heart attack or stroke?
• Which factors are contributing most to that risk?
• How much difference could a statin make for me?
• Could I try lifestyle changes first?
• What should I do if I experience side effects?
• How will my treatment be monitored and reviewed?

There is no benefit in treating a cholesterol number without considering the person behind it. The purpose of taking a statin is to reduce your future chance of heart attack or stroke by an amount that feels worthwhile to you.

Once you understand your overall risk, the likely benefit of treatment and the available alternatives, you can make the decision with your doctor rather than feeling that it has been made for you.

About the author

Dr Peter Kabunga is a Consultant Cardiologist and Electrophysiologist with extensive experience in heart health, particularly in diagnosing and managing conditions such as high cholesterol and its impact on cardiovascular risk. He works within the NHS at Darent Valley Hospital and King’s College Hospital and is accredited in cardiac electrophysiology by the British Heart Rhythm Society.