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Statins: Should I Take Them to Prevent a Heart Attack or Stroke?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Statins: Should I Take Them to Prevent a Heart Attack or Stroke?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Start taking a medicine called a statin to help prevent coronary artery disease and lower your risk of heart attack and stroke.
- Don't take a statin. Try to lower your risk with healthy lifestyle habits alone.
Is this decision for you? This could be a decision for you if you do not have coronary artery disease and have not had a heart attack or a stroke. If you have been diagnosed with coronary artery disease or peripheral arterial disease (PAD) or if you have had a heart attack or a stroke, this information is not for you. Statins are strongly recommended for people with these conditions.
Key points to remember
- Statins can help prevent coronary artery disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.
- If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.
- You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.
- Some people who take statins have side effects.
- A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.
How can you know your risk of heart attack and stroke?
Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:
- Your cholesterol numbers.
- Your blood pressure.
- Whether you have diabetes.
- Your age, gender, and race.
- Whether you smoke.
Your doctor might talk about your risk of having a heart attack or a stroke in the next 10 years. There are different online tools that doctors can use to calculate this risk. These tools are not perfect. They may show that your risk is higher or lower than it really is. But the tools can give you and your doctor a good idea about your risk.
Why might your doctor recommend taking a statin?
Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.
If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of coronary artery disease, to decide if medicine may be right for you.
In general:
- People at high risk will get more benefit from taking a statin than those at low risk.
- People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.
What is a heart-healthy lifestyle?
Everyone can help lower their risk of a heart attack or stroke with a heart-healthy lifestyle. This includes:
- Eating vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
- Being active on most days of the week. To lower risk, try to do moderate exercise at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
- Losing weight if you need to, and staying at a healthy weight.
- Not smoking.
- Managing other health problems. These include diabetes and high blood pressure.
A heart-healthy lifestyle is important whether you take statins or not. Medicines don't take the place of healthy habits.
How do statins work?
Statins lower the amount of bad (LDL) cholesterol in your blood.
Cholesterol is a type of fat in your blood. Your body needs it for many things, such as making new cells. But if you have too much cholesterol, it starts to build up in blood vessels called arteries. This problem is called atherosclerosis. It is the starting point for most heart and blood flow problems, including heart attacks and strokes.
Statins lower bad cholesterol by reducing how much of it your body makes. Statins also decrease inflammation around the cholesterol buildup (called a plaque). This may lower the risk that the plaque will break apart and cause a blood clot that can lead to a heart attack or stroke.
What are the side effects of statins?
Some people who take statins report that they have more muscle aches. But it's not clear whether these are actually a side effect of statins.footnote 1
A less common issue is diabetes. Statins may slightly raise the risk of diabetes in some people. This risk seems to be sightly higher in people who already have risk factors for getting diabetes.
The decision to take a statin is up to you. You can try it, and if you don't like the way it makes you feel, you can talk with your doctor. You may choose to take a different statin or a different dose to try to avoid side effects.
What do numbers tell us about benefits and risks of statins?
Benefits
| Risk of heart attack or stroke | With statins | Without statins |
|---|---|---|
| Low risk | 2 out of 100 | 3 out of 100 |
| Moderate risk | 8 out of 100 | 10 out of 100 |
| High risk | 15 out of 100 | 20 out of 100 |
* These numbers are estimates based on research studies. The quality of the evidence is high.footnote 2footnote 3
Evidence shows that statins may lower the chance of having a heart attack or stroke, especially for people who are at high risk.
Take a group of 100 people with a low risk of heart attack or stroke. Here are their chances of having one in the next 10 years:footnote 2footnote 3
- If they don't take statins, about 3 out of 100 will have a heart attack or stroke. This means that about 97 out of 100 won't.
- If they do take statins, about 2 out of 100 will have a heart attack or stroke. This means that about 98 out of 100 won't.
Take a group 100 people with a moderate risk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:
- If they don't take statins, about 10 out of 100 will have a heart attack or stroke. This means that about 90 out of 100 won't.
- If they do take statins, about 8 out of 100 will have a heart attack or stroke. This means that about 92 out of 100 won't.
Take a group of 100 people with a high risk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:
- If they don't take statins, about 20 out of 100 will have a heart attack or stroke. This means that about 80 out of 100 won't.
- If they do take statins, about 15 out of 100 will have a heart attack or stroke. This means that about 85 out of 100 won't.
Risks
Risk of muscle aches
More research is being done to better understand the chances of having muscle problems from taking statins. Some people who take statins report that they have more muscle aches. But it's not clear how often these are actually a side effect of statins.footnote 1
Risk of diabetes
| Risk | With statins | Without statins |
|---|---|---|
| Getting diabetes | 5 out of 100 | 4 to 5 out of 100 |
* These numbers are estimates based on research studies.footnote 4
Evidence shows that statins may raise the risk of diabetes in some people. The quality of this evidence is moderate. This risk seems to be slightly higher in people who already have risk factors for getting diabetes.
Take a group of 100 people. Here are their chances of getting diabetes in the next 4 years:footnote 4
- With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.
- Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.footnote 2footnote 5footnote 4footnote 3
The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
Compare your options
Compare
What is usually involved? | | |
|---|---|---|
What are the benefits? | | |
What are the risks and side effects? | |
- You take a pill every day.
- You also have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.
- Studies show that statins can lower the risk of heart attack and stroke.
- Statins provide the most benefit for people at high risk of heart attack and stroke.
- Some people who take statins report that they have more muscle aches. It's not clear whether these are actually a side effect of statins.
- Statins may slightly increase the risk of diabetes.
- You have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.
- Healthy habits alone can help lower your risk of heart attack and stroke without the possible side effects of medicine.
- You avoid the bother and cost of taking a pill every day.
- Healthy habits alone may not lower your risk as much as healthy habits plus a statin would.
Stories about deciding whether to take a statin to lower heart attack and stroke risk
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight.
Becky, age 56
My cholesterol is high, but I really don't like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good.
Diego, age 41
My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine.
Charles, age 48
I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk.
Carole, age 58
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take statins
Reasons not to take statins
I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.
I'm not very worried about my risk of heart attack and stroke.
I don't mind taking medicine if it will reduce my risk of heart attack and stroke.
I hate the idea of taking a pill every day.
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
I'm already doing everything I can to reduce my risk through heart-healthy habits.
I could do more to reduce my risk by improving my habits.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking statins
NOT taking statins
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- Newman CB, et al. (2019). Statin safety and associated adverse events: A scientific statement from the American Heart Association. Atherosclerosis, Thrombosis, and Vascular Biology, 39(2): e38–e81. DOI: 10.1161/ATV.0000000000000073. Accessed October 16, 2020.
- Taylor F, et al. (2013). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (1): 1–96. DOI: 10.1002/14651858.CD004816.pub5. Accessed January 8, 2014.
- Yusuf S, et al. (2016). Cholesterol lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine, 374: 2021–2031. DOI: 10.1056/NEJMoa1600176. Accessed May 27, 2016.
- Sattar N, et al. (2010). Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet, 375(9716): 735–742.
- Joy T, et al. (2009). Narrative review: Statin-related myopathy. Annals of Internal Medicine, 150(12): 858–868. DOI: 10.7326/0003-4819-150-12-200906160-00009. Accessed April 7, 2015.
Statins: Should I Take Them to Prevent a Heart Attack or Stroke?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Start taking a medicine called a statin to help prevent coronary artery disease and lower your risk of heart attack and stroke.
- Don't take a statin. Try to lower your risk with healthy lifestyle habits alone.
Is this decision for you? This could be a decision for you if you do not have coronary artery disease and have not had a heart attack or a stroke. If you have been diagnosed with coronary artery disease or peripheral arterial disease (PAD) or if you have had a heart attack or a stroke, this information is not for you. Statins are strongly recommended for people with these conditions.
Key points to remember
- Statins can help prevent coronary artery disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.
- If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.
- You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.
- Some people who take statins have side effects.
- A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.
How can you know your risk of heart attack and stroke?
Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:
- Your cholesterol numbers.
- Your blood pressure.
- Whether you have diabetes.
- Your age, gender, and race.
- Whether you smoke.
Your doctor might talk about your risk of having a heart attack or a stroke in the next 10 years. There are different online tools that doctors can use to calculate this risk. These tools are not perfect. They may show that your risk is higher or lower than it really is. But the tools can give you and your doctor a good idea about your risk.
Why might your doctor recommend taking a statin?
Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.
If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of coronary artery disease, to decide if medicine may be right for you.
In general:
- People at high risk will get more benefit from taking a statin than those at low risk.
- People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.
What is a heart-healthy lifestyle?
Everyone can help lower their risk of a heart attack or stroke with a heart-healthy lifestyle. This includes:
- Eating vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
- Being active on most days of the week. To lower risk, try to do moderate exercise at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
- Losing weight if you need to, and staying at a healthy weight.
- Not smoking.
- Managing other health problems. These include diabetes and high blood pressure.
A heart-healthy lifestyle is important whether you take statins or not. Medicines don't take the place of healthy habits.
How do statins work?
Statins lower the amount of bad (LDL) cholesterol in your blood.
Cholesterol is a type of fat in your blood. Your body needs it for many things, such as making new cells. But if you have too much cholesterol, it starts to build up in blood vessels called arteries. This problem is called atherosclerosis. It is the starting point for most heart and blood flow problems, including heart attacks and strokes.
Statins lower bad cholesterol by reducing how much of it your body makes. Statins also decrease inflammation around the cholesterol buildup (called a plaque). This may lower the risk that the plaque will break apart and cause a blood clot that can lead to a heart attack or stroke.
What are the side effects of statins?
Some people who take statins report that they have more muscle aches. But it's not clear whether these are actually a side effect of statins.1
A less common issue is diabetes. Statins may slightly raise the risk of diabetes in some people. This risk seems to be sightly higher in people who already have risk factors for getting diabetes.
The decision to take a statin is up to you. You can try it, and if you don't like the way it makes you feel, you can talk with your doctor. You may choose to take a different statin or a different dose to try to avoid side effects.
What do numbers tell us about benefits and risks of statins?
Benefits
| Risk of heart attack or stroke | With statins | Without statins |
|---|---|---|
| Low risk | 2 out of 100 | 3 out of 100 |
| Moderate risk | 8 out of 100 | 10 out of 100 |
| High risk | 15 out of 100 | 20 out of 100 |
* These numbers are estimates based on research studies. The quality of the evidence is high.23
Evidence shows that statins may lower the chance of having a heart attack or stroke, especially for people who are at high risk.
Take a group of 100 people with a low risk of heart attack or stroke. Here are their chances of having one in the next 10 years:23
- If they don't take statins, about 3 out of 100 will have a heart attack or stroke. This means that about 97 out of 100 won't.
- If they do take statins, about 2 out of 100 will have a heart attack or stroke. This means that about 98 out of 100 won't.
Take a group 100 people with a moderate risk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:
- If they don't take statins, about 10 out of 100 will have a heart attack or stroke. This means that about 90 out of 100 won't.
- If they do take statins, about 8 out of 100 will have a heart attack or stroke. This means that about 92 out of 100 won't.
Take a group of 100 people with a high risk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:
- If they don't take statins, about 20 out of 100 will have a heart attack or stroke. This means that about 80 out of 100 won't.
- If they do take statins, about 15 out of 100 will have a heart attack or stroke. This means that about 85 out of 100 won't.
Risks
Risk of muscle aches
More research is being done to better understand the chances of having muscle problems from taking statins. Some people who take statins report that they have more muscle aches. But it's not clear how often these are actually a side effect of statins.1
Risk of diabetes
| Risk | With statins | Without statins |
|---|---|---|
| Getting diabetes | 5 out of 100 | 4 to 5 out of 100 |
* These numbers are estimates based on research studies.4
Evidence shows that statins may raise the risk of diabetes in some people. The quality of this evidence is moderate. This risk seems to be slightly higher in people who already have risk factors for getting diabetes.
Take a group of 100 people. Here are their chances of getting diabetes in the next 4 years:4
- With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.
- Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.2543
The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
2. Compare your options
| Take statins to lower your risk of heart attack or stroke | Don't take statins | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Stories about deciding whether to take a statin to lower heart attack and stroke risk
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight."
— Becky, age 56
"My cholesterol is high, but I really don't like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good."
— Diego, age 41
"My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine."
— Charles, age 48
"I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk."
— Carole, age 58
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take statins
Reasons not to take statins
I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.
I'm not very worried about my risk of heart attack and stroke.
I don't mind taking medicine if it will reduce my risk of heart attack and stroke.
I hate the idea of taking a pill every day.
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
I'm already doing everything I can to reduce my risk through heart-healthy habits.
I could do more to reduce my risk by improving my habits.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking statins
NOT taking statins
5. What else do you need to make your decision?
Check the facts
1. Do statins benefit people at low risk of heart attack or stroke as much as people at high risk?
- Yes
- No
- I'm not sure
2. Do you still need healthy habits even if you take a statin medicine?
- Yes
- No
- I'm not sure
3. Is it true that your risk of heart attack and stroke is based only on your cholesterol?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- Newman CB, et al. (2019). Statin safety and associated adverse events: A scientific statement from the American Heart Association. Atherosclerosis, Thrombosis, and Vascular Biology, 39(2): e38–e81. DOI: 10.1161/ATV.0000000000000073. Accessed October 16, 2020.
- Taylor F, et al. (2013). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (1): 1–96. DOI: 10.1002/14651858.CD004816.pub5. Accessed January 8, 2014.
- Yusuf S, et al. (2016). Cholesterol lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine, 374: 2021–2031. DOI: 10.1056/NEJMoa1600176. Accessed May 27, 2016.
- Sattar N, et al. (2010). Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet, 375(9716): 735–742.
- Joy T, et al. (2009). Narrative review: Statin-related myopathy. Annals of Internal Medicine, 150(12): 858–868. DOI: 10.7326/0003-4819-150-12-200906160-00009. Accessed April 7, 2015.
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Current as of: July 31, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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