Questions about statins

It's normal to have questions when you might need to take a new medicine.

Statins have been around for over 30 years and have been prescribed to millions of people in the UK. They are the most widely used medicine to lower cholesterol, but there have been a lot of news stories about them which can be confusing.

Your doctor should only prescribe them when there is a real clinical need. Taking a statin helps to reduce your risk of heart attacks, strokes and other diseases, along with other medication you may be taking. So, if you do have questions about statins, it’s important to find the answers you need. These frequently asked questions should help.

I am taking a statin, do I need to bother with my diet?

Even if you are taking a statin, improving your diet, becoming more physically active and stopping smoking is still encouraged. Not only can these lifestyle changes help improve your cholesterol and future risk of heart and blood vessel diseases, they can also help improve your general heart health and well-being.

 Do statins work? 

There are many scientific studies which support the use of statins in protecting against diseases of the heart and blood vessels (known as cardiovascular disease or CVD).

The Cholesterol Treatment Trialists’ Collaboration (CTTC) included more than 170,000 people and showed the benefits of statins in people with or without a history of CVD. Statins were clearly shown to lower LDL cholesterol levels.

For every 1mmol/L drop in LDL cholesterol, importantly, there was also a drop in patients' 5-year risk of CVD.

The study showed the risk of all major events such as heart attacks and strokes fell by 21%.

How well do statins work? 

The table shows how much different statins can lower LDL cholesterol by. This is reproduced from the Summary of National Guidance for Lipid Management for
Primary and Secondary Prevention of CVD, by the Accelerated Access Collaborative (ACC) and the NHS, 2021, endorsed by NICE. 

Approximate reduction in LDL cholesterol

Ezetimibe, when combined with any statin, is likely to give greater reduction in non-HDL-C or LDL-C than doubling the dose of the statin.

Key:

(l) Low intensity statins will produce an LDL-C reduction of 20-30%

(m) Medium intensity statins will produce an LDL-C reduction of 31-40%

(h) High intensity statins will produce an LDL-C reduction above 40%

(s) Simvastatin 80mg is not recommended due to risk of muscle toxicity 

What are the possible side effects?

Most people don't have any side effects when they take a statin and most take them every day without any problems. Side effects can occur with all medications, and the most commonly reported side effects of statins are muscle aches and pains.

It is sometimes difficult to know if muscle aches and pains are linked with taking a statin or with general day-to-day life. Usually, stopping the statin for a few days under supervision from your doctor will show you if it is actually the statin. 

There are five different statins that can be prescribed in the UK. The statin usually prescribed is known as atorvastatin. If the one that has been prescribed for you is not suitable, your doctor can try a different one, or a lower dose of the one you are taking. Anyone with muscle pains should also have a blood test (read more below)

How do I know if I’m getting side effects from a statin?

The muscle ache and pain that some people get with statins use are typically a generalised muscle discomfort lasting more than a couple of days, similar to the muscle aches caused by the flu. It is usually all over the body and does not just affect one part. It is not joint pain or localised cramp.

If you experience this symptom, don’t ignore it, talk to your doctor. In the vast majority of cases these symptoms will disappear, but you should not stop taking ayourstatin without  speaking to your doctor first and trying a different type. They may suggest stopping the statin for a short time to see if the symptoms go away. Sometimes there can be other reasons for symptoms and it is important that your doctor considers these as well.

What can raise the risk of side effects?

The risk of side effects increases with:

• advancing age
• other medications which work in a similar way
• other medical conditions
• higher alcohol consumption
• heavy exercise.

How can I report any side effects?

If you think you are experiencing any side effects from a statin, talk to your doctor before stopping the medication taking it. It might help to keep a symptom diary to record what symptoms you have and how bad they are. This should make it easier for you to describe and discuss them with your GP when you see them.

All reports of side effects are taken extremely seriously by the manufacturer and the Medicines and Healthcare Products Regulatory Agency (MHRA). The yellow card scheme allows you to report suspected side effects of any medicine you’re taking.

What are the very rare side effects of statins?

In a small number of cases, muscle pain can progress to other muscle-related problems such as:

• myopathy – a muscle disease where the muscle no longer functions well enough
• myositis – inflammation of the muscle
• rhabdomyolosis – where muscle cells are broken down. This is very rare. 

If the GP suspects myopathy, they should request a blood test to look for raised levels of Creatinine Kinase (CK), a muscle enzyme. Symptoms like muscle tenderness and soreness are often linked to a rise in CK. A modestly raised CK level is not necessarily caused by the statin, as CK levels can be very variable, even in healthy people not on any treatment. They can rise naturally when you exercise, for example. Your doctor will have a guideline on this that they can follow. 

Ideally, your GP should compare the results of the new CK test with any tests you had before you started taking statins. This should help your doctor to see what’s causing your symptoms and help you and your doctor decide what to do next.

Occasionally, muscle pain can be present without a raised CK level.

What are the alternatives to statins?

Most people who take a statin don't experience any problems. For those who do, trying a lower dose of the same statin or switching to a different one can solve the problem.

There are also other medications available for those who can't take a statin, or it is not working well for them. These include ezetimibe, which is the next treatment after a statin; bempedoic acid, and either PCSK9 inhibitors or Inclisiran.

Where can I find out more about the safety of statins?

For more on the safety of statins for other health conditions, visit our research page and the following consensus statements. 

• Consensus statement on statin safety from the EAS (European Atherosclerosis Society). Adverse effects of statin therapy: perception vs the evidence – focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Mach, F. Ray, K. et al (2018). European Heart Journal. 2018 Jul 14; 39(27): 2526–2539.

• Scientific statement on statin safety from the American Heart Association. Statin Safety and Associated Adverse Events:  A Scientific Statement From the American Heart Association. Newman, C., Preiss, D et al (2018) Arterioscler Thromb Vasc Biol. 2019;39:e38-e81.