Imagine you go to see your doctor for a blood test. After reading the report, the doctor says, "Your LDL (bad) cholesterol level is a little high." The first question that comes to your mind is, "Oh, do I have to take this cholesterol-lowering medication now?" The answer to this is not as simple as it used to be. It's a little more complicated now. Let's get to the bottom of it.
How do you decide to give a statin?
In the past, there were clear rules for this. If your blood cholesterol level was above a certain level, your doctor would advise you to make lifestyle changes and start you on a statin drug.
A healthy lifestyle is still essential. That means eating a healthy diet, cutting back on saturated fat, and getting regular exercise . But the answer to the question of whether to take statins is a little different now. This changed after the American Heart Association (AHA) and the American College of Cardiology (ACC) updated their guidelines.
Currently, only if your bad cholesterol (LDL) level is very high (190 mg/dL or higher) will you start a medication based on that level. Otherwise, your doctor will consider several other factors. For example:
- Do you have diabetes?
- According to a specific risk calculator, is your risk of having a heart attack or stroke within the next 10 years 7.5% or higher?
Many factors like these are now taken into account when making a decision. But one thing to remember is that some doctors do not follow these new guidelines exactly. Therefore, before giving you a medication, your doctor will talk to you about all the other risk factors that affect heart disease.
Ultimately, the decision to take a statin is a decision that you and your doctor should make together, so it's important to be well-informed about this.
What really happens with these statins?
Simply put, a statin is a type of cholesterol-lowering medication. If you take one, your bad cholesterol (LDL) levels can be reduced by 35% to 50% or more, depending on the type and dose you take. This can significantly reduce your risk of having a heart attack or stroke.
Statins work in our liver. They block an enzyme in our body that makes cholesterol. In addition, they do another important thing. That is, they stabilize the cholesterol deposits (plaque) that are attached to the walls of our blood vessels and reduce the inflammation that occurs with them. This is very important, because if these cholesterol deposits (plaque) suddenly burst, it can form a blood clot and cause a heart attack or stroke.
There is no problem in giving statins to someone who has already had a heart attack or stroke, because these drugs have been very strongly proven to help prevent a second heart attack or stroke.
Do statins have side effects?
Like any medication, statins can have side effects. However, not everyone gets them. Let's take a look at the most common and rare side effects.
| Side Effect | Explanation |
|---|---|
| Muscle pain | This is the most common side effect. It can affect 5% to 20% of people taking the medication. If this happens, talk to your doctor about switching to a different statin, reducing the dose, or trying taking it every other day instead of every day. Never stop taking your medication without first talking to your doctor. |
| Liver damage | This is very rare. Your doctor will order blood tests to check your liver enzymes if necessary. If you are taking other medications (e.g. Panadol), tell your doctor about them as well. |
| Diabetes risk | Some studies have shown that taking statins can cause a small increase in blood sugar levels. However, this condition usually occurs in people who are already at high risk for developing diabetes (e.g., overweight, metabolic syndrome). |
| Other rare effects | Memory loss, confusion, and neuropathy have been reported very rarely. These usually only affect those taking high doses. |
What else should you consider when taking medication?
Whether you decide to take a statin or not, lifestyle changes are a must. There is no escape from that.
Remember, 80% - 90% of heart disease is caused by risk factors that we can change. That means we have a great chance of preventing these.
This is based on a good nutritious diet (reduced sugar), an active lifestyle, avoiding smoking, and controlling your body weight. Sometimes, if you make significant changes to your lifestyle, you can reduce the amount of medication you need to take. This also reduces the risk of side effects.
However, there are some things we can't change, such as your age and genes. So, some people may need medication even if they have a good lifestyle.
Talk to your doctor.
If you still have doubts about this, the best thing to do is to talk openly with your doctor about it. Ask him for more information about this. Discuss additional factors such as whether anyone in your family has heart disease (family history), what your C-reactive protein (CRP) level is, and whether you have had gestational diabetes.
Sometimes, before prescribing a medication, the doctor may perform a special scan to check for calcium deposits in the blood vessels.
Although statins are very useful drugs, they are not suitable for everyone. If you do not get enough results from statins, or if you cannot take them due to side effects, there are other types of cholesterol-lowering drugs.
The most important thing is to talk to your doctor about this regularly. Tell him everything you're feeling, your questions, your fears. He'll listen to you and help you make the decision that's best for you.
Take-Home Message
- Statins are very effective drugs for lowering cholesterol. But they are not necessary for everyone. The decision to take this drug or not is something you and your doctor should make together.
- Whether you take medication or not, maintaining a healthy lifestyle (good diet, exercise, and no smoking) is essential. That is the foundation of treatment.
- The most common side effect of statins is muscle pain. If you experience any of these, tell your doctor immediately. Never stop taking your medication or change your dosage without your doctor's advice.
- Your risk of heart disease is determined not only by your blood cholesterol (LDL) levels, but also by many other factors, such as your age, family history, and other health conditions.
- To make the best decisions about your health, always communicate openly and honestly with your doctor.
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