If you take a statin or have been recommended to take a statin, you likely think it’s to lower your cholesterol. And that’s partially right, but it’s not the full story.
Statins are among the most prescribed and controversial medications. There is a lot of conflicting information about statins, and if you feel unclear about the benefits of a statin, you’re not alone. Less than 60% of those who would benefit from a statin aren’t taking one. The result is thousands of preventable heart attacks, strokes, and premature deaths.
How do you make sure you’re not one of them?
Not just cholesterol.
Susan, a recent patient of mine, asked me, “Why should I take a cholesterol medication if my cholesterol is not high?”
Susan is seeing me because she had a heart attack and wants to make sure she is doing everything possible to prevent another one.
She is active and “feels great.” However, she stopped her statin because her cholesterol numbers have always been good.
She was surprised when I recommended she start retaking the statin.
What are Statins?
Statins are commonly referred to as “cholesterol medications.” Statins are among the most prescribed medications, and they do more than just lower cholesterol.
There is a lot of debate about who should be taking a statin medication. While there are passionate people on both sides, often the “right” answer is mostly dependent on the goals of the patient.
Some people want to do what they can to prevent heart attacks and stroke, and taking a statin makes sense to them. Others don’t want to take a medication or are concerned about the potential side effects of statins. Who’s right? I believe they both are, as long as the decision is based on understanding the real risks and benefits, and not perceived risks or false information. I see my role as a cardiologist to explain the real risks and benefits of medications and not to tell my patients what to do. It’s your right to decide what makes the most sense to you.
The first place I start is to emphasize that the controversy around statins is not whether they are effective. Statins are among the best-studied medicines in history, and the evidence is clear. Statins are proven to decrease the risk of heart attack, stroke, and death in those who are at high risk for heart disease. The controversy is more often, how do we define “high-risk”?
The second thing I emphasize is that while 90% of people don’t have side effects to statins, about 10% do, including me. And taking a medication that makes you miserable now to avoid problems in the future, doesn’t make sense to me.
They’re Not Just for Cholesterol.
So, back to Susan, why did I recommend that Susan restart her cholesterol med if her cholesterol numbers were good?
There are two reasons: 1. What is defined as “good” cholesterol numbers depend on your risk. Cholesterol numbers that are perfectly acceptable in a young person with no risk factors could be unacceptable in someone with a high risk of heart disease. Because Susan had a heart attack in the past, she is in a high-risk group.
2. Statins have been shown to lower risk, even in those with normal or low cholesterol numbers. Rather than “cholesterol meds,” statins would be more appropriately called “risk meds.”
Once Susan knew why she was prescribed a statin, she was glad to start retaking it.
Why do you take a statin?