Should I take statins for high cholesterol?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Lowering your high cholesterol can help you prevent a heart attack or stroke. Consider the following when making your decision:

• High cholesterol is only one of several risk factors for heart disease. To reduce your risk of coronary artery disease (CAD) and heart attack, you need to reduce all of your risk factors, not just high cholesterol.
• Guidelines from the U.S. National Cholesterol Education Panel recommend more intensive treatment with statins for people who are at moderate to very high risk of CAD.¹ It is important, however, that you discuss with your doctor whether statins are appropriate for you individually, based on your condition and medical history.
• The choice is less clear for people who have moderately high cholesterol and few risk factors for CAD and heart attack. This group may find this decision point most helpful.
• Therapeutic lifestyle changes are as important as medicine in reducing your risk for CAD and heart attack. For some people, quitting smoking, reducing blood pressure, losing weight, or getting more exercise can have the same or greater impact on reducing the risk of heart disease than taking medicine.

Medical Information

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What is cholesterol, and why is high cholesterol dangerous?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But too much cholesterol in your blood increases your chances of heart attack and stroke.

What raises my chances of getting CAD and having a heart attack or stroke?

Your chances are higher if you:

• Are a man age 45 or older or a woman age 55 or older.
• Have a family history of CAD: CAD in your father or a brother younger than 55 or in your mother or a sister younger than 65.
• Have smoked any cigarettes within the past 30 days.
• Have high blood pressure (140/90 mm Hg or above) or are taking medicine for high blood pressure.
• Have a low HDL cholesterol level (below 40 mg/dL or 0.91 mmol/L).
• Have diabetes.

What are other risk factors?

Other factors that put you at risk for CAD and heart attack include high homocysteine levels, obesity and lack of regular exercise, menopause and the drop in estrogen that follows it, and metabolic syndrome.

Your Information

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An important part of your decision about whether to take statins is determining your risk for coronary artery disease and heart attack.

Use this Interactive Tool: Are You at Risk for a Heart Attack?

Along with medical guidelines for taking medicines, your decision about whether to take statins to lower your cholesterol level includes your personal feelings.

Deciding about using statin medicines

Reasons to use statin medicines

Reasons not to use statin medicines

Your LDL cholesterol is over 190 mg/dL. Your total cholesterol is over 240 mg/dL. You have two or more risk factors for CAD or have a condition as serious as CAD. Medicine is easy and convenient to use. You have tried being more active and making changes to your diet, but it did not lower your cholesterol to the target you set. Statins are proven to lower the risk of heart attack, stroke, and death in people with high cholesterol who have a high risk of heart attack and stroke.2, 3 Your HDL is low and you have a family history of heart disease or stroke. Statins reduce LDL by 18% to 55%.4 Statins increase HDL by 5% to 15%.4 Statins reduce triglycerides by 7% to 30%.4 Are there other reasons why you might want to use medicines to lower cholesterol?

Your LDL cholesterol is below 100 mg/dL. You may have to take medicine for the rest of your life. You may need periodic blood tests to check liver function. You may be able to reduce cholesterol levels through diet and exercise. Medicines are expensive if insurance does not pay for them. You may have side effects from taking medicine. Are there other reasons why you might not want to use medicines to lower cholesterol?

Medicine choices

Statins are the most effective and widely prescribed cholesterol-lowering medicine. They include:

• Atorvastatin (Lipitor).
• Atorvastatin with amlodipine (Caduet).
• Ezetimibe with simvastatin (Vytorin).
• Fluvastatin (Lescol).
• Lovastatin (Mevacor).
• Pravastatin (Pravachol).
• Rosuvastatin (Crestor).
• Simvastatin (Zocor).

Other medicines also lower cholesterol, and some may be used to lower triglycerides or raise HDL. They include:

• Bile acid sequestrants: cholestyramine (Questran) and colestipol (Colestid).
• Fibric acid derivatives: gemfibrozil (Lopid) or fenofibrate (Tricor).
• Nicotinic acid: (Nicolar, Niacor, Niaspan, and Slo-Niacin).

These medicines are sometimes used in combination with a statin.

These personal stories may be helpful in making your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you will have a better idea of how you feel about taking medicine to lower cholesterol levels. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My doctor has told me that my risk for CAD is high.	Yes	No	Unsure
My LDL cholesterol level is above 190 milligrams per deciliter (mg/dL).	Yes	No	Unsure
The NCEP guidelines recommend that I take medicine.	Yes	No	Unsure
I have the finances and/or insurance to pay for medicine.	Yes	No	Unsure
I worry about my cholesterol levels.	Yes	No	Unsure
I worry about getting CAD or having a heart attack.	Yes	No	Unsure
I believe that medicine can help me.	Yes	No	Unsure
I am comfortable with taking medicines long-term or for the rest of my life.	Yes	No	Unsure
I feel I can cope with the side effects of cholesterol-lowering medicine.	Yes	No	Unsure
Having to take regular blood tests for liver function doesn't bother me.	Yes	No	Unsure
Medicine that I'm currently taking does not interfere with medicine to lower cholesterol.	Yes	No	NA*
Diet and exercise have helped me lower my cholesterol.	Yes	No	NA
I have difficulty staying on a diet.	Yes	No	NA
I have difficulty staying with an exercise program.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicines.

Check the box below that represents your overall impression about your decision.

Leaning toward taking medicine

Leaning toward NOT taking medicine

Return to the topic High Cholesterol.

References

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Citations

1. 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.]

2. Foster C, et al. (2004). Primary prevention. Clinical Evidence (11): 163–195.

3. Pignone M, et al. (2004). Secondary prevention of ischaemic cardiac events. Clinical Evidence (12): 193–235.

4. 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.

Credits

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Author	Ralph Poore
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology
Last Updated	July 20, 2006