I’ve written extensively on statins. I consider them our most powerful tool for preventing and treating atherosclerosis, the disease that blocks off arteries and causes heart attacks and strokes.
Like all medications, they need to be used wisely and after a process of shared-decision making with the patient in which a realistic discussion of the risks and benefits takes place.
Statin Drugs: Risks, Benefits and the New Guidelines
Should All Men Over Sixty Take a Statin Drug?
Statin Benefits Beyond Cholesterol Lowering
Am I Sabotaging My Heart With Statin Drugs?
Coronary Calcium Scans To Aid in Statin Decision
The decision on whether or not to take a statin drug for primary prevention is a difficult one. For those who have not had heart attacks, strokes, bypass surgery or stents I utilize coronary calcium testing to determine if we are dealing with advanced or premature build-up of plaques in the coronary arteries.
Go to the coronary calcium page for all my posts on that subject.
If you have evidence for coronary disease or atherosclerosis which is not that advanced you may end up being on the fence about taking a statin.
Read my posts about Geo, the man on the fence here and here and learn about a compromise approach to statin therapy that might work for you.
Costs of Statins
Although Big Pharma has profited from brand-name statins in the past, all of the major statins now are generic and should be cheap.
Our most powerful statin (brand name Crestor, generic rosuvastatin) went generic a few years ago and we are still working out how to find the cheapest version.
See here for a discussion on why rosuvastatin for some is expensive and be sure to check reader comments on ways to source cheaper rosuvastatin.
A Song About Statin Songs by a mostlly off-kilter Dr. P & the atherosclerotics
16 thoughts on “Statin Drugs”
Dr A, my husband is 63 and very fit and athletic. His mother’s side has a frightening family history of heart attacks of men in their 40s. His dad’s side is long lived with no heart issues. His total cholesterol has always been around 200. He tried statins over the years but they gave him muscle pain and made him feel lousy so he stopped.
Knowing the family history, he has been vigilant about his health. Unlike his male relatives who smoked and were sedentary and fat, he has always been fit and active, no smoking, moderate alcohol, lors of green leafy veggies. He went on keto in December 2018 and lost 25 pounds so he is back to his HS weight although he was never all that fat. Over the years his allergies were not well controlled and he had some chronic inflammation from some undiagnosed infections but now he feels great on keto. He had a CAC done late 2019 and we are stunned by his 900 score. His doc wants to do statins, but we wonder, is this all we can do and will it stop his disease progression? He has no metabolic syndrome, his blood work is fantastic. Literally he is the last person you would ever expect to have extensive heart disease. CAC tells us he is a sitting duck with a gun aimed at him, but every doc says they can’t do anything , just statins. Really?
Dear Dr. AnthonyP I have been on Lipitor for some 9 months. Minimal side effects, though my memory gradually seems to be worsening. After reading the below listed article, I wonder if I should stop taking it. I find this article, extremely comprehensive and convincing. What’s your take?
Gerald M. Rehert, M.D.
My feelings on this haven’t changed since I wrote …https://theskepticalcardiologist.com/2017/08/20/do-statins-cause-memory-loss-the-science-the-media-the-statin-denialist-cult-and-the-nocebo-effect/
I use a lot of statins and just don’t see this. However, as I indicate in that post I listen to patients and always recommend a trial off the drug to look for improvement.
If you find that your memory returns then a reapprraisal of risk/benefits and alternative treatments is in order.
Malhotra, IMHO, is a publicity-seeking alarmist. I am constantly reviewing the evidence for statin benefits and side effects and I see nothing to suggest that their efficacy and safety is a hoax or a cover-up.
I am 61 years old, and have had problems with high cholesterol since I was in my mid 30s, when I was at the fittest and careful on what I ate or drank, I was a size 10 slim, muscles to die for, I had a personal trainer and trained at the gym 6 morning a week, I ran 5 km most nights! my cholesterol at the time got diagnosed at 6.4 the doctor wanted to put me on statins immediately, I refused and for many years have done so. 2 years ago I was reading on the benefits of red rice monokolina 10 which though I could’t get in Australia, it was liberally sold overseas. I got my friend to send me some, after one year of taking this, my cholesterol is now on the normal count and I only take the monokolina 10 red rice, ever second day for maintenance. Do you have any proof or info on this? I know that it works wonder with me!!
I am a 73.5 years old and a 44 year endurance runner. I have no CAD or heart disease and follow no particular diet at all. I eat mostly beans, corn, fruit, and some meat mostly Bison. I do love the meat. My idea is that opinions on statins, diets, heart disease and every other disease should be research based and scholarly. There are too many fads and misinformation. I am very fortunate that at my age I take no medications and need absolutely no treatments. My secret to great health is simple. Avoid all the fads and focus on the highest level of fitness you can achieve. My friends, mostly dead or disabled now, used to tell me not to run because I was getting old at 55 and sixty. I didn’t feel old so just continued to do it more intensely as the years passed. Then 10 years ago I picked up rowing and weight training. No one can convince me that any medication or doctor is better for you than breaking 12 METS 3 to 4 times per week. As for statins, they treat high cholesterol and high cholesterol is determined by risk factors and age. RCT’s have conclusively shown that statins reduce morbidity and mortality for CVD. RTC’s are the best level of proof you can have without absolute certainty.
I have been on atorvastatin for 20 years and have battling anxiety that gets worse as time goes by. I just read about the possible connection between statins and seratonin receptors. My A1C has also increased over time. Otherwise I am a very healthy 58 year old with no other health problems. I started on atorvastatin because I had a calcium screening 20 years ago that showed plague. My cholesterol is down to 172 now but the anxiety is hardly tolerable. Have you looked at the connection between statins and anxiety??
I’m not aware of any connection between statins and anxiety. Anxiety is common and statin usage common but I think they are not related.
I haven’t had any patients who experience anxiety due to statins.
Thank you so much for taking the time to respond!
As a slim, fit 57 year old woman who eats a healthy low-carb diet, Type II diabetes wasn’t even on my radar. I have never been overweight, never smoked, exercise 6-7 days per week and have no family history of diabetes.
Unfortunately, after starting 10mg. of atorvastatin two years ago my A1C has jumped from normal (5.0) to 5.7 – pre-diabetes. Other than the atorvastatin I take no prescription drugs or supplements and haven’t gained weight or changed my diet over the past two years.
After discussing with my PCP, I decided to stop the atorvastatin for a 4 month period to see if that has any impact on my A1C. (Obviously I’m hoping I can put the brakes on the diabetes train!). If my A1C improves I’m still left with the quandary about how to address my high cholesterol.
(A course of Accutane years ago skyrocketed my cholesterol to a whopping 300, and it has refused to budge).
I’m glad I stumbled across this very informative blog. I’m leaning towards a consult with a cardiologist to assess whether or not I stand to benefit from statin therapy as a primary prevention. I’m grateful for all the (non-hysterical) information provided here on the pros and cons of statins – many thanks, doc!
I just read the following:
It is quite frightening. I would normally not pay attention to this recent anti-statin info but this is so extensive and full of statistics I need another opinion.
It is quite extensive with an overwhelming array of statistics.
But the authors don’t appear to have any significant credentials and they appear to have an agenda to cherry pick the data to support their opinions.
I recommend ignoring it.
I’ve read numerous medical articles on the dangers of statins and research showing cholesterol does not cause heart disease. I hope to see more positive article like this!
I have the impression that long-term studies with statins have not included sufficient numbers of females. I also have the impression that quitting statins will, not might, but will result in cardiovascular events. No?
This paper (http://www.sciencedirect.com/science/article/pii/S0140673614613684?via%3Dihub) reviewed all patients in something called the cholesterol trialist database and found 46 thousand women who had participated in randomized trials of statin therapy, a pretty large number.
Here’s there summary, bottom line being women had similar proportional reduction in vascular events with statins.
46 675 (27%) of 174 149 randomly assigned participants were women. Allocation to a statin had similar absolute effects on 1 year lipid concentrations in both men and women (LDL cholesterol reduced by about 1·1 mmol/L in statin vs control trials and roughly 0·5 mmol/L for more-intensive vs less-intensive therapy). Women were generally at lower cardiovascular risk than were men in these trials. The proportional reductions per 1·0 mmol/L reduction in LDL cholesterol in major vascular events were similar overall for women (rate ratio [RR] 0·84, 99% CI 0·78–0·91) and men (RR 0·78, 99% CI 0·75–0·81, adjusted p value for heterogeneity by sex=0·33) and also for those women and men at less than 10% predicted 5 year absolute cardiovascular risk (adjusted heterogeneity p=0·11). Likewise, the proportional reductions in major coronary events, coronary revascularisation, and stroke did not differ significantly by sex. No adverse effect on rates of cancer incidence or non-cardiovascular mortality was noted for either sex. These net benefits translated into all-cause mortality reductions with statin therapy for both women (RR 0·91, 99% CI 0·84–0·99) and men (RR 0·90, 99% CI 0·86–0·95; adjusted heterogeneity p=0·43).
I would not agree that quitting statins “will result in cardiovascular events”. It will increase risk but not all who quit will have an event.
Yes, I am on the fence. Just learned via a CAC test that I score moderate disease in the Widowmaker artery, LAD and Left Main Anterior. They want to give me potent statins–the newest injection of antibodies in the stomach. Yet I have been studying the Keto diet–family members on it, one an RN in a neuro ICU, who’s lost 25 lbs and feels fantastic after 12 hour shifts that he used to collapse into bed with. Have heard of so many risk factors, have taken them before and have a hard time tolerating them. I’m at an impasse with it.
Do you know your CAC score and your percentile?
The ketogenic diet may help you reduce weight and thereby lower your risk over time but if you have a high CAC score for your age and gender that is >75th percentile you should consider statin therapy until the diet has been effective for a while.