Weighing the Benefits vs. Side Effects of Statins: Are They Worth the Risks?

High cholesterol is a common condition, affecting almost 40% of American adults. It has no symptoms, so many people don’t know they have it. 

But even though you can’t feel it, it’s still important to treat high cholesterol. This is so you can avoid serious complications like heart disease, stroke, and atherosclerosis (fatty buildup in your arteries). Together, these are called “cardiovascular disease.”

What are statins?

Statins are a common medication prescribed to treat high cholesterol. Typically, they are the first type of medication people take to lower cholesterol. 

Statins have been FDA approved and available for use in the U.S. since 1987. As a result, they have been studied extensively. And in most cases, statins have been found to be the most effective medications for lowering cholesterol levels. 

Examples of popular statins include:

• Atorvastatin (Lipitor)

• Simvastatin (Zocor)

• Rosuvastatin (Crestor)

• Pravastatin (Pravachol)

• Lovastatin (Mevacor)

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How do statins work?

Statins work by blocking the action of an enzyme that allows your liver to make cholesterol. They also help the liver to get rid of excess cholesterol in the body. By blocking the production of cholesterol and helping to remove it, statins lower the amount of cholesterol in your blood.

The main effect of statins on cholesterol is to lower the level of low-density lipoprotein (LDL) cholesterol. This is usually referred to as the “bad” kind of cholesterol because it raises your risk of heart disease. Statins also lower your triglycerides (fats in the blood). Together, these actions help to decrease your risk of cardiovascular disease.

But they have another benefit: Statins help to increase your level of high-density lipoprotein (HDL) cholesterol (“good cholesterol”). This type of cholesterol helps to absorb bad cholesterol from your arteries and takes it to the liver, where it’s removed from the body. 

When are statins prescribed for high cholesterol?

Your provider may prescribe a statin for you if:

• You already have cardiovascular disease (like heart attack or stroke).

• You have a high risk for cardiovascular disease (for example, you smoke, or you have high blood pressure).

• You have diabetes.

• You have very high cholesterol levels.

• You have familial hypercholesterolemia (high cholesterol due to genetic reasons).

• You tried dietary and lifestyle changes with no improvement.

How effective are statins for lowering cholesterol?

Statins work well to lower LDL cholesterol, regardless of your levels. But your results will depend on which statin you take, and the dose. For example, rosuvastatin 40 mg may lower your LDL by up to 60%. 

Statins also work well to lower triglycerides. But it depends on how high they are to begin with. If you have very high triglycerides, statins can lower them by up to 45%. You may not see a dramatic improvement if you have modestly high triglycerides.

What are the side effects and risks of statins?

Most people tolerate statins well, but there are risks and side effects to be aware of. 

The most commonly associated risks include:

1. Muscle pain

This is the most common side effect that statin users report. And it’s the most common reason people decide to stop taking statins. Muscle pain can range in severity from mild aches to rhabdomyolysis (severe muscle breakdown).

Up to 20% of people may have some muscle complaint with statins. And it's not well understood why it happens. But there are some risk factors that make this side effect more likely:

• Genetic predisposition

• Previous history of increased creatine kinase (CK) levels

• Neuromuscular disease (like myasthenia gravis or spinal muscular atrophy)

• Hypothyroidism

• Family history of muscle disorder

2. Diabetes

Statins may increase your risk of getting diabetes by about 10%. The higher your statin dose, the higher your risk of developing diabetes. Diabetes is also more likely to occur when statins are used over time.  

It’s unclear why this happens. But there are some people who are more likely to develop diabetes while taking statins:

• Older people 

• People with higher than normal blood sugar levels or prediabetes (glucose intolerance)

• People with a heavier body weight

3. Liver damage

In rare cases, statins can cause high liver enzymes. These are lab tests that indicate damage to liver cells. This only occurs in about 1% of people who take statins. And it is usually linked to taking a high dose of statins.

In most cases, abnormal liver enzymes are temporary — and return to normal levels with repeat lab testing. Statins don’t typically cause serious liver complications or liver failure. But  you should still have your liver enzymes checked before starting a statin.  

4. Other common side effects of statins

In addition to these risks, there are other side effects that statin users may commonly see. These include:

• Stomach upset (diarrhea, constipation, nausea or gas)

• Fatigue

• Dizziness

• Headache

So, should you take a statin?

If you have high cholesterol and are at high risk for cardiovascular disease, you should consider statins. That’s because the benefits of statins greatly outweigh the risks. Statins reduce the risk of serious cardiovascular events like heart attack or stroke by up to 25%, and death by 10%. 

Statins can also help to reduce the risk of heart disease and stroke even if your LDL cholesterol levels are low. And they can lower the risk of cardiovascular disease in some people who may have  high levels of inflammation in the arteries even if their cholesterol levels are normal.

Some people are more likely to get statin side effects than others

There are several things that increase the likelihood of having side effects while taking statins. People are more likely to have side effects from statins when:

• They take a higher statin dose.

• They take other medications with statins, like cyclosporine, gemfibrozil, or azithromycin.

• They are over the age of 65.

There are also genetic factors that can put you at risk for statin side effects. Researchers have found several genes that can impact the way you process and absorb statins. This can lead to higher statin drug levels and a higher risk for side effects.  

If you have any of these risk factors, talk with your healthcare provider about a safe way to try statins or other options that may work for you.

Managing statin side effects

Fortunately, severe side effects from statins are rare, and most people find that side effects improve over time. You can manage side effects by lowering the dose, stopping for a while, or changing the statin. 

If these strategies don’t work and you are unable to tolerate statins, let your provider know. There are other options available.

Are there any alternatives to statins?

Alternative medications are available for people who can’t or don’t want to take a statin. Some of these medications help to lower cholesterol levels, and some also lower the risk of heart attack and stroke. Here are some examples:

• Zetia

• PCSK9 inhibitors (like Repatha, Praluent)

• Fibrates (like fenofibrate, gemfibrozil)

• Niacin, and omega-3 fatty acids (to lower triglyceride levels)

• Bile acid sequestrants (like cholestyramine, colesevelam)

• Nexletol

Several lifestyle changes also help lower cholesterol levels. And they can decrease your risk of cardiovascular disease. These heart-healthy lifestyle recommendations include:

• Eating a healthy diet (like plant-based, Mediterranean)

• Consuming more fiber 

• Exercising (aerobic and resistance training)

• Not smoking

• Decreasing alcohol intake

Why trust our experts?

Written by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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