Are Statins a Life-Long Commitment?

Doctor and patient having a discussion about a statin prescription.

Our bodies are amazing, but sometimes they need a little bit of help. If you’ve had a cholesterol check recently, your doctor may have discussed adding a statin to your daily routine to help reduce your risk of a heart attack or stroke. You might be wondering, can you stop taking statins once you start? Lipid Specialist Sanford Carimi, MD, UnityPoint Health, tackles that question, plus explains what a statin is and possible side effects.

What are Statins?

“Statins are a class of drugs that lower the blood levels of cholesterol produced in the liver by blocking an enzyme needed to make cholesterol from fats,” Dr. Carimi explains.

The Federal Drug Administration (FDA) approved the first statin in 1987. Some common brand names of statins include Lipitor and Crestor and some generics are simvastatin, pravastatin, atorvastatin and rosuvastatin.

Statins are a medication taken long-term, instead of for a set amount of time, like you might experience with antibiotics for an infection.

Who is Prescribed a Statin?

People with elevated risks for heart disease, including those who smoke, have diabetes, a strong family history of early heart disease or high LDL (bad) cholesterol levels, are often candidates to talk about statins with their doctor.

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“Some people have family histories of early heart disease and extremely high levels of LDL cholesterol, which is anything over 190 and can be significantly higher,” Dr. Carimi says.

Statins are also usually prescribed to people who’ve already had a heart attack or who’ve been diagnosed with coronary artery disease (CAD). CAD is the most common type of heart disease and occurs when the arteries supplying blood to the heart become hard or narrow.

“In people with known CAD, statins offer about a 25 percent reduction in cardiac events, like heart attacks, and a roughly 20 percent reduced risk for stroke.”

What are the Side Effects of Statins?

Dr. Carimi says muscle-related complications are the most common side effect from taking statins.

“The most common reason people stop taking statins is because of side effects, like muscle aches, but many have muscle pains from other causes and stop taking the medication in error,” Dr. Carimi says.

If you experience muscle aches, Dr. Carimi says to talk to your doctor. You can work with him/her to reduce your dose or try a different statin to reduce side effects. He says your provider can also check for low thyroid levels or low vitamin D levels, which could also be increasing your discomfort.

There has been some concern about statins and the medication connection to diabetes. Dr. Carimi says not to worry.

“Certain strong statins have shown to slightly increase the risk of diabetes, but only in people who are already pre-diabetic. That means they are already on the verge of being diabetic, before statin use begins. While these stronger statins may elevate blood sugar to a small degree, the benefits of reducing heart attack and stroke strongly outweigh the smaller risk associated with mildly higher sugar levels,” Dr. Carimi says.

Can You Stop Taking Statins Once You Start?

If you’ve experienced a heart event or stroke and your doctor prescribes a statin, Dr. Carimi says it’s best to stick with the medication. He says the risk is too high, even if you’re now living a better, healthier lifestyle. However, if you haven’t had a stroke or heart attack and you are taking statins due to high cholesterol numbers, ending statin use might be an option. Dr. Carimi says you must first start with lifestyle improvement, like diet and exercise, then have discussion about risk with your doctor.

“I always use the analogy of driving a car over the speed limit. If you’re driving a little over the speed limit, it slightly increases your risk of a crash. If you drive significantly over the limit, your risk of an accident significantly increases. Your cholesterol is like the speed of your car. If your cholesterol number is way over the limit, your risk of a heart attack or stroke increases. When you stop statin use, you have to weigh your risks.”

Dr. Carimi says most people stop statin use because of side effects or because they don’t understand the risks and how statins are helping the body work effectively. He says some people even try using supplements, like red yeast rice, instead of taking prescription statins. Dr. Carimi says that approach is not a good idea because experts haven’t studied it extensively, and the safety of long-term use isn’t clear.

“Red yeast rice is basically just a lower dose statin. It is less regulated for safety from contaminants and still has risks for side effects without the proven cardiovascular risk reduction at the lower dose levels. While ‘natural’ sounds safer, it may not be. Cyanide is natural, but I would not call it safe either,” Dr. Carimi says.

Can Lifestyle Change Prevent the Need for a Statin?

Dr. Carimi says he always wants people to try to be healthier without the need for medications, when possible.

“If a patient hasn’t had a heart attack, coronary or peripheral artery vascular disease, they should look at their predicted cardiovascular risk. If it’s less than 7.5 percent, they can make improvement with a healthier lifestyle.”

Dr. Carimi makes these recommendations:

  • Regular, moderately strenuous exercise most days of the week (with doctor approval)
  • Avoid trans fats in the diet
  • Watch portion sizes
  • Keep well hydrated with water
  • Reduce stress
  • Get regular, complete nights of sleep 
  • Quit smoking and avoid secondhand smoke
  • Maintain a healthy weight

“I always tell people that lifestyle changes typically lower LDL cholesterol by about 15 percent versus a statin, which can lower the level by about 50 percent. So, I encourage those patients with very high LDL cholesterol levels to still consider statin use,” Dr. Carimi says.

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