Statins: Frequently Asked Questions

An interview with

Carl E. Orringer, M.D.,
Director of Preventative Cardiovascular Medicine,
University of Miami Health System

Statins play an important role in lowering cardiovascular risks. When I see patients, they often ask particular questions regarding this beneficial and effective treatment.

How much will a statin benefit me, and why should I take it?

I want to emphasize that although statins lower cholesterol, that is not the main reason we give it.

We give it because it reduces the risk of heart attack and stroke.

So, if your goal is to reduce your risk of a stroke, or if your goal is to reduce your risk of a heart attack, statins in the appropriate patients can make a big, big difference.

What if I just take a little bit versus higher doses?

We decide the dosage to give a person dependent upon their risk.

Things we consider are:

• if you have had a recent heart attack
• if you have a stent or a coronary bypass operation, stroke, or blocked arteries in your legs
• if you’ve gone to the hospital with a situation where doctors see active evidence of heart disease

In these scenarios, we typically use higher doses of statins because there is evidence that higher doses provide the greatest benefit. But in some instances, we can get by with moderate doses, when appropriate.

Should I worry about muscle-related side effects from statins?

Statin-associated muscle symptoms typically are described as occurring on both sides of the body, not just on one side, and in the large muscles of the upper legs and the large muscles of the upper arms. These tend to occur within a couple of days to a few weeks of starting the statin. Oftentimes, they will go away within about two weeks of stopping the statin.

However, these muscle side effects occur only in about 9% of people who take statins. When they do occur, we have many strategies that we can use to help get around them.

For instance, we can try a different dose of a different statin. Another option is using a very low dose of a statin in combination with ezetimibe, which is a statin booster and can give us all of the benefits we need even with a low dose of a statin.

Can statins ruin my liver?

Statins are so safe on the liver that the food and drug administration does not require that we monitor liver functions in people taking them.

There have been rare responses in which some people have sustained some liver injury from statins – basically, only one in more than 100,000 cases. But, even when that occurs, the problem goes away when the patient stops taking the statin.

What about kidney disease or diabetes?

There is no good evidence that statins worsen kidney disease.

Regarding diabetes – in large studies of statins, there’s a slight signal for an increased risk for diabetes. That only tends to occur in those prone to diabetes, those who have strong family histories of diabetes, those carrying a lot of weight, or those who are eating very poor and unhealthy diets.

Plus, if a person develops diabetes while taking a statin, the treatment of choice is a statin. That is because most people with diabetes die of heart attack or stroke, so the beneficial effects of giving a statin to a person with diabetes far outweigh any risk.

Do statins increase the risk of Alzheimer’s disease?

Evidence suggests that statins reduce the risk of small strokes that contribute to Alzheimer’s disease. So, I want to emphasize that there is no good evidence that statins cause Alzheimer’s disease.

What about using PCSK9 Inhibitors?

These injectable medicines are given once every two weeks. When used in combination with a statin in certain high-risk people, they reduce heart attack and stroke risk and can dramatically lower a person’s LDL cholesterol. These medicines are very well tolerated; however, the downside is that they’re expensive.

Most people who require PCSK9 Inhibitors can get it covered by their insurance, but it’s not nearly as cost-effective as taking statins or ezetimibe. So, we reserve it for patients at extremely high risk and those who can get insurance coverage for the medications.

How safe is it to lower your LDL cholesterol, the so-called bad cholesterol?

In 2021, we published a paper in the European Heart Journal looking at that very topic. I’m happy to tell you that our investigations showed very low LDL cholesterol levels that are sometimes attained with the use of statins, ezetimibe, and PCSK9 Inhibitors.

They don’t seem to be associated with any major adverse side effects. Our study also showed that the lower the LDL cholesterol was, the lower the risk for heart attack. We want your LDL cholesterol as low as possible, especially if you’ve had a heart attack or previous stent or bypass because that tends to be associated with the best outcomes.

Am I at risk for a heart attack?

Learn more and find out if you qualify for a heart attack assessment.

Tags: cardiovascular health, cardiovascular risk, Dr. Carl Orringer, expert answers, statins