Everything you need to know about coming off statins

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Statins reduce LDL cholesterol levels in the blood. LDL cholesterol is a waxy, fatty substance that builds up in the walls of arteries. These deposits restrict blood flow through the arteries and cause inflammation, which increases the risk of heart attack and stroke.

Statins work in two ways. First, they reduce the liver’s production of cholesterol. Second, they help the liver reabsorb and break down cholesterol in the arteries’ walls. Statins also have anti-inflammatory effects.

A person may want to come off statins for various reasons, including side effects and a perceived lack of need. However, taking statins is typically a lifelong commitment.

The majority of people who take statins do not experience any side effects. As with all drugs, however, a small minority experience mild to severe side effects when taking statins.

The adverse effects that they most commonly experience are muscle problems and a slightly increased risk of type 2 diabetes, which we cover in more detail.

Muscle problems

In rare cases, people taking statins report muscle pains, tenderness, or weakness. In rare cases, statins may damage the muscles.

If a person taking statins experiences muscle aches, pains, or weakness and cannot link these symptoms to an obvious cause, such as exercise or physical labor, they should speak to a doctor.

A doctor can test a person’s blood creatine kinase (CK) levels. The body releases CK when the muscles are damaged or inflamed. If a person has a high CK level, a doctor may advise stopping statin treatment.

Type 2 diabetes

Hyperglycemia, or increased blood sugar, is a potential side effect of statins. A person may hesitate about taking statins if they have concerns about their risk of developing type 2 diabetes.

A review from 2019 reported a slightly increased risk of newly diagnosed type 2 diabetes among people taking this type of medication. The risk is highest among people with prediabetes. Taking statins increases type 2 diabetes risk by 0.2% for each year that a person takes the medication.

In a person with normal baseline blood glucose levels, statins are highly unlikely to cause diabetes. The benefits of taking statins to prevent a cardiac event usually outweigh the risk of developing diabetes.

Pregnancy

The risk of statins causing pregnancy and birth complications is rare. However, doctors recommend that a person who is pregnant or who is planning a pregnancy refrain from taking statins in the majority of cases.

Exceptions to this include people with pre-established cardiovascular disorders, who may require statin use through pregnancy to ensure their health.

Perceived reduced need

Some lifestyle changes can help people manage their cholesterol levels. Examples include exercising regularly, maintaining a healthy weight, and eating a balanced diet.

However, people who adopt these lifestyle changes should not assume that they can stop taking statins. To determine whether this is the case, a doctor can use blood tests to check that cholesterol levels are within a healthy range.

People who are considering coming off statins should discuss this with their doctors. Stopping statin treatment can be dangerous for certain people, especially those who have a history of stroke, heart attack, or stenting.

A 2017 study investigated whether quitting or reducing statin use increased the risk of a second ischemic stroke (IS) in people who had previously been in the hospital for the condition.

The study included a total of 45,151 participants. It found that people who quit taking statins 3–6 months after having an IS were 42% more likely to experience a second stroke within 6–18 months.

There was no increased risk for people who continued to take statins at a reduced dose.

Anyone considering coming off statins should first discuss it with their doctor. A medical professional can assess a person’s health and medical history to determine whether reducing or discontinuing statin therapy is safe.

Taking a lower dosage of statins may mean incorporating another cholesterol-lowering drug into the treatment plan. However, this will not always be possible, and in some instances, people will need to take statins for life.

In rare cases, a doctor may suggest stopping statin treatment altogether and replacing it with a different cholesterol-lowering drug. A doctor may prescribe any of the following drugs as an alternative to statins:

PCSK9 inhibitors

PCSK9 is a protein that reduces the liver’s ability to absorb LDL cholesterol from the blood.

PCSK9 inhibitors bind to and inactivate the protein. This allows the liver to absorb more LDL cholesterol and reduce its levels in the blood. Drugs in this class include alirocumab (Praluent) and evolocumab (Repatha).

Selective cholesterol absorption inhibitors

Selective cholesterol absorption inhibitors (SCAIs) prevent cholesterol absorption in the small intestine.

These drugs mainly reduce LDL cholesterol. They may also slightly increase high-density lipoprotein, or “good” cholesterol.

Other treatment options

Other complementary treatment options include lipid-lowering therapies, which reduce levels of triglyceride fats in the blood.

Examples of lipid-lowering drugs and supplements include:

• fibrates, such as gemfibrozil (Lopid), fenofibrate (Tricor), and clofibrate (Atromid-S)
• niacin, which is a form of vitamin B-3
• vascepa, which is a type of omega-3 fatty acid

Statins reduce LDL cholesterol, lowering the risk of heart attack and stroke. There are many reasons that a person may want to come off statins. Some people experience or are concerned about side effects. Others may feel that they no longer need to take this type of drug.

Anyone who wants to stop taking a statin should talk with a doctor. In some cases, coming off these drugs can be dangerous.

The doctor may suggest reducing the dosage, combining the statin with another cholesterol-lowering drug, or switching to another drug entirely.