Statins are a class of medications that reduce cholesterol levels in the blood, especially low-density lipoprotein. Doctors prescribe statins to prevent complications in people with high cholesterol and heart disease.

Cholesterol is a waxy, fatty substance in the blood that can build up in the arteries. Low-density lipoprotein (LDL) cholesterol is particularly likely to build up and can cause a condition called atherosclerosis, where the arteries harden, increasing the risk of cardiovascular disease and stroke.

Read on to learn more about the role of statins in managing or treating high cholesterol. This article also looks at types of statins, who might benefit from statins, possible side effects, and more.

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While people get extra cholesterol from food, the liver makes its own cholesterol. An enzyme called hydroxymethylglutaryl-CoA (HMG-CoA) signals the liver that it should make more cholesterol.

Statins, also called HMG-CoA reductase inhibitors, block or reduce the activity of the HMG-CoA enzyme, meaning that the liver makes less LDL cholesterol.

As the liver makes less LDL cholesterol, it also takes more LDL cholesterol from the blood, reducing the levels that move around the body.

Statins can also help reduce triglycerides (blood fats) and may boost levels of high-density lipoprotein (HDL) cholesterol.

Several statins have approval from the Food and Drug Administration (FDA), including:

  • atorvastatin
  • fluvastatin
  • lovastatin
  • pitavastatin
  • pravastatin
  • rosuvastatin
  • simvastatin

These may differ by how much the body absorbs, which enzymes process the statin, how the statins interact with cells, and how the body gets rid of them after use.

Some medication combinations also contain statins. These include:

  • simvastatin/niacin extended-release (Simcor)
  • simvastatin/ezetimibe (Vytorin)
  • lovastatin/niacin extended-release (Advicor)
  • atorvastatin/amlodipine (Caduet)

Doctors prescribe statins for people who have a type of cardiovascular disease (CVD), such as:

A doctor may also recommend statins if a person has a high risk of developing CVD within the next 10 years.

People with certain genetic conditions may also benefit from statins. Examples include:

Statins can have a high, moderate, or low level of intensity based on how much they reduce LDL cholesterol. Doctors measure LDL cholesterol in milligrams per deciliter (mm/dL).

Doctors may prescribe statins if LDL cholesterol is high, typically at least 190 mm/dL.

However, they may also prescribe statins for people ages 45–70 years with an LDL cholesterol level of 70 mm/dL if they have diabetes or a high risk of CVD or stroke.

People often take statins for the rest of their lives. Stopping the medication causes cholesterol to increase in just a few weeks.

People who plan to become pregnant should contact a doctor about stopping statins roughly 3 months before the intended pregnancy.

The following groups of people need to avoid taking statins:

  • pregnant people
  • people who are breastfeeding or nursing
  • people who have liver disease

A growing fetus needs cholesterol to develop, so significantly reducing levels during pregnancy can be harmful. A person will need to contact their doctor if they are taking statins and are thinking about becoming pregnant.

Statins are generally safe and effective for most people. Although they can have side effects and complications, these are extremely rare.

According to a 2019 statement from the American Heart Association, statins carry the following risk of certain complications:

  • around a 0.2% risk of developing diabetes per year of taking statins, depending on the person’s preexisting risk of diabetes
  • less than a 0.1% risk of muscle injury and breakdown, known as rhabdomyolysis
  • around a 0.001% risk of severe liver damage

In people with cerebrovascular disease, statins may increase the risk of a type of stroke called hemorrhagic stroke. However, they also help to prevent atherothrombotic stroke, which is stroke due to atherosclerosis.

Statins may interact with other medications, which can cause muscle damage. People should also avoid drinking grapefruit juice while taking statins, as this increases the risk of interactions.

Common side effects of statins include:

Less often, statins may cause the following:

  • memory problems
  • vomiting
  • a pins and needles sensation
  • flu-like symptoms due to hepatitis (inflammation of the liver)
  • stomach pain due to pancreatitis (inflammation of the pancreas)
  • acne and other skin problems
  • loss of libido and other sexual problems

In rare cases, statins can cause:

Certain factors increase the risk of muscle-related side effects, according to a 2019 review. These include:

  • a personal or family history of muscle problems with other medications for lowering lipid levels
  • having a history of unexplained cramps
  • a history of elevated creatine kinase levels
  • untreated hypothyroidism
  • taking high doses of statins
  • being over the age of 80 years
  • being assigned female at birth
  • a high grapefruit juice consumption
  • vitamin D deficiency
  • having a low body mass index (BMI)
  • excess physical activity or exercise

It is important to inform a doctor about any side effects a person experiences when taking statins.

Following a doctor’s instructions may reduce the risk of side effects with statins.

It is important not to stop taking statins without first contacting a doctor. They can advise on foods to avoid that may contribute to interactions or request a blood test to check for muscle damage.

Side effects may resolve if a doctor switches the prescription to a different statin. Muscle damage is rare and may heal after changing medications.

Statins are not the only treatment for high cholesterol. Many other approaches can help people manage their cholesterol levels and reduce their CVD risk.

Other medications include:

Learn more about cholesterol medications.

Other steps that may help include:

  • making dietary changes to manage cholesterol, such as eating foods with less trans fats and saturated fats
  • getting enough regular exercise or physical activity
  • maintaining a moderate weight
  • managing stress
  • quitting smoking where applicable
  • limiting alcohol consumption
  • taking red yeast rice supplements at a doctor’s advice, as monacolin K performs a similar activity to statins

Here are some frequently asked questions about statins.

What cholesterol level requires statins?

People with an LDL cholesterol level of at least 190 mg/dL may receive a statin prescription. Those over 45 years old may benefit from statins at 70 mg/dL or higher if they have diabetes or a high CVD or stroke risk.

Which statin is best for lowering cholesterol?

Rosuvastatin is the most potent statin. Atorvastatin has the next most significant effect on blood cholesterol. However, the best statin for lowering cholesterol is the one that best suits a person’s blood cholesterol level and general health profile. Some statins may be more suitable for some people than others.

What are the downsides of statins?

In rare cases, statins can increase a person’s risk of liver toxicity, muscle damage, diabetes, and certain types of stroke. They can also interact with other medications and certain foods, such as grapefruit juice.

A person can discuss the benefits and risks of taking statins with their doctor.

Why do some doctors not recommend statins?

Doctors will not prescribe statins for people who are pregnant or breastfeeding. They may not recommend statins for groups with a higher risk of side effects, including people who are over 70 years old or have liver disease, hypothyroidism, or a family history of rhabdomyolysis.

They may also avoid prescribing statins to people who take drugs that have a risk of interactions. It is important for people to let a doctor know about any other medications they are taking before they begin taking statins.

Statins can help lower high cholesterol levels. They cause the liver to make less low-density lipoprotein (LDL) cholesterol, which reduces blood cholesterol levels and can help lower a person’s risk of heart disease and stroke.

A person with high cholesterol usually needs to take statins for the rest of their lives, along with exercise and diet measures to manage cholesterol.

Statins are generally safe and effective for most people, but in rare cases, they can increase a person’s risk of liver damage and other complications. Statins are also not suitable for people who are pregnant or nursing.