High cholesterol: Should I take statins?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
High cholesterol: Should I take statins?
Get the facts
Your options
- Start taking medicine for high cholesterol.
- Don't take medicine. Try lowering your cholesterol with
lifestyle changes.
Key points to remember
- You may be able to improve your
high cholesterol with lifestyle changes, such as
eating less saturated fat, losing weight if you need to, exercising, and
quitting smoking.
- If high cholesterol runs in your family, you may
not be able to lower it with lifestyle changes alone. You may need to take
medicines called
statins or statin combinations to lower your
cholesterol.
- If you have high cholesterol and
diabetes,
high blood pressure, or
coronary artery disease, you may need to start taking
medicine right away. That's because your chances of having a heart attack are
high, and
statins can reduce this risk.
- Statins can
reduce "bad"
LDL cholesterol and increase "good"
HDL cholesterol.
- Statins can lower your
risk of having a heart attack or a stroke.
- Statins have few side
effects. Any side effects, such as muscle aches, feeling tired, or having an
upset stomach, are most likely when higher doses are used. Statins do not cause
side effects in most people.
- Even with medicine, you will need
healthy habits for the rest of your life to lower your risk of a heart
attack.
FAQs
Cholesterol is a
type of fat. Your body needs it for many things, such
as making new cells. But if you have too much, it starts to build up in your
arteries. The higher your cholesterol, the greater your risk for heart disease.
Too much cholesterol in your blood can lead to a
heart attack or a
stroke.
There are two kinds of
cholesterol.
Triglycerides are another type of fat in the blood. If
you have high triglycerides and high LDL, your chances of having a heart attack
are higher.
A simple blood test tells you how much cholesterol you
have. The test results are given in numbers. Your cholesterol numbers help your
doctor know your
risk of heart attack. To find out this risk, your doctor will also consider
your age, your family history, your blood pressure, and if you smoke.
- LDL should be low.
Your LDL goal depends on your risk of heart attack and stroke. If you are at
very high risk, your goal may be less than 70. If you are at high risk, your
goal is less than 100. If you are at moderate risk, your goal is less than 130.
If you are at low risk, your goal is less than 160.
- HDL should be high. A good HDL goal is 40 or higher. HDL over
60 helps protect against a heart attack. HDL below 40 increases your risk of
heart problems. A high HDL number can help offset a high LDL
number.
- Triglycerides should be less than
150. A level above 150 may increase your risk for heart problems.
High cholesterol is just one of several risk factors
that make heart attacks or strokes more likely. If you have high cholesterol
and another risk factor, heart attacks and strokes are
even more likely. Some risk factors are things you may be able to control.
Others are things you can't control.
Risk factors you
may be able to control include:
Risk factors that you can'tcontrol include:
- Your age. Men age 45 or older and women age
55 or older have a higher risk.
- Having one or more
close relatives who have or had early heart disease.
To find out your risk of a heart attack, you can use the
Interactive Tool: Are You at Risk for a Heart Attack?
Therapeutic lifestyle changes and medicines called
statins are the two main treatments for high
cholesterol. The goal of treatment is to lower your "bad" LDL cholesterol and
reduce your risk of a heart attack or a stroke. You may also need to raise your
"good" HDL cholesterol. A high level of HDL helps lower your risk of heart
problems.
The way high cholesterol is treated will depend on your
cholesterol levels, your risk for a heart attack, and your personal preference
about taking medicines.
Why are lifestyle changes so important?
Some
people can lower their cholesterol just by making lifestyle changes such as
eating less saturated fat, losing weight, exercising, and quitting smoking..
Others will need to take pills as well. But some lifestyle changes are
important for everyone with high cholesterol. Even with statins, you will need
healthy habits for the rest of your life to lower your risk of a heart
attack.
If you decide to try lifestyle changes first, you and
your doctor may want to set a deadline. For example, you might decide that you
will try lifestyle changes for 3 to 6 months. If your cholesterol doesn't come
down enough in that time, you may decide to start taking statins.
If high cholesterol runs in your family, you may not be able to lower it with
lifestyle changes alone. You may need to take pills to keep your cholesterol
down. And if you have high cholesterol and
diabetes,
high blood pressure, or
coronary artery disease, your doctor may want you to
starting taking medicine right away. That's because your chances of having a
heart attack are high, and statins can reduce this risk.
How can statins help lower cholesterol?
Statins and statin combinations are medicines that reduce the body's natural
production of cholesterol. They make "bad" LDL cholesterol levels in the blood
go down and help lower triglycerides. Statins can also raise "good" HDL
cholesterol. Statins may be used alone, or they may be combined with other
medicines.
Guidelines from the United States
National Cholesterol Education Panel advise use of statins in people who are at
moderate to high risk of
coronary artery disease.1
To find out your risk of a heart attack, you can
use the
Interactive Tool: Are You at Risk for a Heart Attack?
Studies show that statins and statin combinations
can:
- Slow the spreadof
heart disease.2, 3
- Lower the risk of heart attack.
- Lower stroke risk.
- Reduce LDL by 18% to 55%.4 This means that if your LDL is 200, taking a statin could
lower your LDL to between 164 and 90.
- Increase HDLby 5% to 15%.4 This means that if your HDL is
60, taking a statin could increase your HDL to between 63 and 69. The higher
your HDL, the better. An HDL of 60 and higher protects against heart disease.
You'll need blood tests to check your liver each year
while you are taking the pills. Statins may cause liver problems, and the blood
tests check how well your liver is working.
Your doctor may recommend that you take statins or statin combinations
if:
- You have high "bad"
LDL cholesterol and low "good"
HDLcholesterol.
- You have
diabetes,
high blood pressure, or
heart disease.
- You are at high risk of
having a heart attack, or you already have heart problems.
- You
have tried being more active and changing your diet, but these changes did not
lower your cholesterol enough.
Compare your options
| | | |
|---|
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
| |
Take statins to lower
your cholesterol Take statins to lower
your cholesterol - You take a pill or combination of pills every day for the rest of
your life.
- You see your doctor for regular blood tests to check how well
your liver is working.
- Studies show that statins and statin
combinations can:
- Lower "bad"
LDL cholesterol and increase "good" HDL cholesterol.
- Slow the spread of
coronary artery disease.
- Lower the risk of
a heart attack.
- Lower the risk of a stroke.
- Statins don't cause side effects in most
people. But possible side effects can include:
- Minor muscle aches.
- Tiredness
- Upset
stomach.
- Gas.
- Constipation.
- Belly pain or
cramps.
- Severe muscle pain (not common).
- These medicines can be costly.
Don't take statins
Don't take statins
- You may be able to lower your cholesterol by making healthy
changes.
- You avoid taking pills every day.
- You avoid the cost
of pills.
- Lifestyle changes may not be enough to lower your cholesterol.
- You may still be at risk for a heart attack or a stroke if your
cholesterol is too high.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
I don't like
taking pills all the time, and I would have to take the cholesterol medicines
for the rest of my life to keep getting any benefit from them. My only other
risk factor is high blood pressure. I need to eat a low-fat diet and get enough
exercise to help keep my weight under control, so I'm going to see if I can get
my cholesterol down a little bit that way (and maybe help my blood pressure,
too).
My dad died of a heart attack when he was
in his 50s. I must have inherited my high cholesterol from him. I don't want to
die before my time, and I haven't been able to get my cholesterol down very
much by eating a low-fat diet. I am going to try the
medicines.
Heart disease runs in our family, so I know
I need to be concerned about my cholesterol and all those other risk factors.
The most important thing for me right now is to quit smoking. From what I have
read, quitting smoking will help reduce my risk of heart disease, lung cancer,
and other problems, and it might help just as much as lowering my cholesterol
would help. It will also be better for my family and will save
money.
I just found out that I have high
cholesterol. Being a smoker, my risk of heart disease is already higher, and
now I have another risk factor to worry about. I have tried many times to quit
smoking, but it has never worked. I want to reduce my risk of heart disease, so
I would like to try taking medicines. If I have some success with that, maybe
it will help motivate me to finally quit smoking.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take statins
Reasons not to take statins
I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.
I want to try to make lifestyle changes to help lower my cholesterol.
More important
Equally important
More important
I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.
I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.
More important
Equally important
More important
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
More important
Equally important
More important
I worry about having a heart attack, and I want to do everything I can to prevent it.
I'm not that worried about having a heart attack.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking statins
NOT taking statins
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1.
Is taking medicine the only way to lower your cholesterol?
- YesSorry, that's not right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
- NoYou're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
- I'm not sureIt may help to go back and read "Why are lifestyle changes so important?" You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weigh, exercising, and quitting smoking.
2.
Can statin medicines help you lower your risk of having a heart attack or stroke?
3.
Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Your summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Author | Robin Parks, MS |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
References
Citations
- Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227–239.
[Erratum in Circulation, 110(6): 763.]
- Cannon CP, et al. (2004). Intensive versus moderate
lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
- Nissen SE, et al. (2004). Effect of intensive compared
with moderate lipid-lowering therapy on progression of coronary
atherosclerosis. JAMA, 291(9): 1071–1080.
- Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.
High cholesterol: Should I take statins?
You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Start taking medicine for high cholesterol.
- Don't take medicine. Try lowering your cholesterol with
lifestyle changes.
Key points to remember
- You may be able to improve your
high cholesterol with lifestyle changes, such as
eating less saturated fat, losing weight if you need to, exercising, and
quitting smoking.
- If high cholesterol runs in your family, you may
not be able to lower it with lifestyle changes alone. You may need to take
medicines called
statins or statin combinations to lower your
cholesterol.
- If you have high cholesterol and
diabetes,
high blood pressure, or
coronary artery disease, you may need to start taking
medicine right away. That's because your chances of having a heart attack are
high, and
statins can reduce this risk.
- Statins can
reduce "bad"
LDL cholesterol and increase "good"
HDL cholesterol.
- Statins can lower your
risk of having a heart attack or a stroke.
- Statins have few side
effects. Any side effects, such as muscle aches, feeling tired, or having an
upset stomach, are most likely when higher doses are used. Statins do not cause
side effects in most people.
- Even with medicine, you will need
healthy habits for the rest of your life to lower your risk of a heart
attack.
FAQs
What is high cholesterol?
Cholesterol is a
type of fat. Your body needs it for many things, such
as making new cells. But if you have too much, it starts to build up in your
arteries. The higher your cholesterol, the greater your risk for heart disease.
Too much cholesterol in your blood can lead to a
heart attack or a
stroke.
There are two kinds of
cholesterol.
Triglycerides are another type of fat in the blood. If
you have high triglycerides and high LDL, your chances of having a heart attack
are higher.
A simple blood test tells you how much cholesterol you
have. The test results are given in numbers. Your cholesterol numbers help your
doctor know your
risk of heart attack. To find out this risk, your doctor will also consider
your age, your family history, your blood pressure, and if you smoke.
- LDL should be low.
Your LDL goal depends on your risk of heart attack and stroke. If you are at
very high risk, your goal may be less than 70. If you are at high risk, your
goal is less than 100. If you are at moderate risk, your goal is less than 130.
If you are at low risk, your goal is less than 160.
- HDL should be high. A good HDL goal is 40 or higher. HDL over
60 helps protect against a heart attack. HDL below 40 increases your risk of
heart problems. A high HDL number can help offset a high LDL
number.
- Triglycerides should be less than
150. A level above 150 may increase your risk for heart problems.
What increases your risk for heart disease and heart attack?
High cholesterol is just one of several risk factors
that make heart attacks or strokes more likely. If you have high cholesterol
and another risk factor, heart attacks and strokes are
even more likely. Some risk factors are things you may be able to control.
Others are things you can't control.
Risk factors you
may be able to control include:
Risk factors that you can'tcontrol include:
- Your age. Men age 45 or older and women age
55 or older have a higher risk.
- Having one or more
close relatives who have or had early heart disease.
To find out your risk of a heart attack, you can use the
Interactive Tool: Are You at Risk for a Heart Attack?
How is high cholesterol treated?
Therapeutic lifestyle changes and medicines called
statins are the two main treatments for high
cholesterol. The goal of treatment is to lower your "bad" LDL cholesterol and
reduce your risk of a heart attack or a stroke. You may also need to raise your
"good" HDL cholesterol. A high level of HDL helps lower your risk of heart
problems.
The way high cholesterol is treated will depend on your
cholesterol levels, your risk for a heart attack, and your personal preference
about taking medicines.
Why are lifestyle changes so important?
Some
people can lower their cholesterol just by making lifestyle changes such as
eating less saturated fat, losing weight, exercising, and quitting smoking..
Others will need to take pills as well. But some lifestyle changes are
important for everyone with high cholesterol. Even with statins, you will need
healthy habits for the rest of your life to lower your risk of a heart
attack.
If you decide to try lifestyle changes first, you and
your doctor may want to set a deadline. For example, you might decide that you
will try lifestyle changes for 3 to 6 months. If your cholesterol doesn't come
down enough in that time, you may decide to start taking statins.
If high cholesterol runs in your family, you may not be able to lower it with
lifestyle changes alone. You may need to take pills to keep your cholesterol
down. And if you have high cholesterol and
diabetes,
high blood pressure, or
coronary artery disease, your doctor may want you to
starting taking medicine right away. That's because your chances of having a
heart attack are high, and statins can reduce this risk.
How can statins help lower cholesterol?
Statins and statin combinations are medicines that reduce the body's natural
production of cholesterol. They make "bad" LDL cholesterol levels in the blood
go down and help lower triglycerides. Statins can also raise "good" HDL
cholesterol. Statins may be used alone, or they may be combined with other
medicines.
Guidelines from the United States
National Cholesterol Education Panel advise use of statins in people who are at
moderate to high risk of
coronary artery disease.1
To find out your risk of a heart attack, you can
use the
Interactive Tool: Are You at Risk for a Heart Attack?
Studies show that statins and statin combinations
can:
- Slow the spreadof
heart disease.2, 3
- Lower the risk of heart attack.
- Lower stroke risk.
- Reduce LDL by 18% to 55%.4 This means that if your LDL is 200, taking a statin could
lower your LDL to between 164 and 90.
- Increase HDLby 5% to 15%.4 This means that if your HDL is
60, taking a statin could increase your HDL to between 63 and 69. The higher
your HDL, the better. An HDL of 60 and higher protects against heart disease.
You'll need blood tests to check your liver each year
while you are taking the pills. Statins may cause liver problems, and the blood
tests check how well your liver is working.
Why might your doctor recommend taking statins?
Your doctor may recommend that you take statins or statin combinations
if:
- You have high "bad"
LDL cholesterol and low "good"
HDLcholesterol.
- You have
diabetes,
high blood pressure, or
heart disease.
- You are at high risk of
having a heart attack, or you already have heart problems.
- You
have tried being more active and changing your diet, but these changes did not
lower your cholesterol enough.
2. Compare your options
| | Take statins to lower
your cholesterol | Don't take statins
|
|---|
| What is usually involved? | - You take a pill or combination of pills every day for the rest of
your life.
- You see your doctor for regular blood tests to check how well
your liver is working.
| |
| What are the benefits? | - Studies show that statins and statin
combinations can:
- Lower "bad"
LDL cholesterol and increase "good" HDL cholesterol.
- Slow the spread of
coronary artery disease.
- Lower the risk of
a heart attack.
- Lower the risk of a stroke.
| - You may be able to lower your cholesterol by making healthy
changes.
- You avoid taking pills every day.
- You avoid the cost
of pills.
|
| What are the risks and side effects? | - Statins don't cause side effects in most
people. But possible side effects can include:
- Minor muscle aches.
- Tiredness
- Upset
stomach.
- Gas.
- Constipation.
- Belly pain or
cramps.
- Severe muscle pain (not common).
- These medicines can be costly.
| - Lifestyle changes may not be enough to lower your cholesterol.
- You may still be at risk for a heart attack or a stroke if your
cholesterol is too high.
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Stories about deciding whether to use medicine for high cholesterol
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I don't like taking pills all the time, and I would have to take the cholesterol medicines for the rest of my life to keep getting any benefit from them. My only other risk factor is high blood pressure. I need to eat a low-fat diet and get enough exercise to help keep my weight under control, so I'm going to see if I can get my cholesterol down a little bit that way (and maybe help my blood pressure, too)."
"My dad died of a heart attack when he was in his 50s. I must have inherited my high cholesterol from him. I don't want to die before my time, and I haven't been able to get my cholesterol down very much by eating a low-fat diet. I am going to try the medicines."
"Heart disease runs in our family, so I know I need to be concerned about my cholesterol and all those other risk factors. The most important thing for me right now is to quit smoking. From what I have read, quitting smoking will help reduce my risk of heart disease, lung cancer, and other problems, and it might help just as much as lowering my cholesterol would help. It will also be better for my family and will save money."
"I just found out that I have high cholesterol. Being a smoker, my risk of heart disease is already higher, and now I have another risk factor to worry about. I have tried many times to quit smoking, but it has never worked. I want to reduce my risk of heart disease, so I would like to try taking medicines. If I have some success with that, maybe it will help motivate me to finally quit smoking."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take statins
Reasons not to take statins
I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.
I want to try to make lifestyle changes to help lower my cholesterol.
More important
Equally important
More important
I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.
I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.
More important
Equally important
More important
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
More important
Equally important
More important
I worry about having a heart attack, and I want to do everything I can to prevent it.
I'm not that worried about having a heart attack.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking statins
NOT taking statins
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1.
Is taking medicine the only way to lower your cholesterol?
You're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
2.
Can statin medicines help you lower your risk of having a heart attack or stroke?
You're right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
3.
Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?
You're right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| Author | Robin Parks, MS |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
References
Citations
- Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227–239.
[Erratum in Circulation, 110(6): 763.]
- Cannon CP, et al. (2004). Intensive versus moderate
lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
- Nissen SE, et al. (2004). Effect of intensive compared
with moderate lipid-lowering therapy on progression of coronary
atherosclerosis. JAMA, 291(9): 1071–1080.
- Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Last Updated:January 30, 2009
Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227–239.
[Erratum in Circulation, 110(6): 763.]
Cannon CP, et al. (2004). Intensive versus moderate
lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
Nissen SE, et al. (2004). Effect of intensive compared
with moderate lipid-lowering therapy on progression of coronary
atherosclerosis. JAMA, 291(9): 1071–1080.
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.