Why do some doctors question statins?
Not because statins don’t work. Trials agree they cut heart attacks and strokes. The question is how much one helps you. Without heart disease, that depends on one number your GP can work out.
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Why do some doctors question statins?
Not because trials show they fail. A Cochrane review of 18 trials in people without heart disease found fewer deaths, heart problems and strokes on a statin.
The questions are about who should take one. In 2013, doctors writing in the BMJ asked whether people at low risk of heart disease should take a statin. There are also long-running worries that statins often cause muscle pain.
The “cholesterol myth” idea goes further. It says cholesterol doesn’t cause heart disease at all.
| Question | What the evidence says |
|---|---|
| Do statins work? | Yes. Trials show fewer heart problems and strokes. |
| Who gains enough? | It depends on your 10-year risk. The higher it is, the more likely you are to benefit. |
| Are side effects common? | Muscle pain is common with or without a statin. About 2 in 100 get it because of the statin. |
| Does cholesterol cause heart disease? | Yes. Studies of over 2 million people show LDL, a type of bad cholesterol, causes artery disease. |
Sources: Cochrane; NICE decision aid; European Atherosclerosis Society
So the fair question isn’t “do statins work?” It’s “is the gain worth a daily tablet for me?”
Ask your GP what your 10-year risk is.
How much would a statin help me?
That’s your QRISK score. Like a weather forecast, it’s a chance, not a promise. At 20%, about 20 in 100 people like you get heart disease or a stroke in 10 years.
Source: NICE decision aid
NICE’s figure at 20% is about 7 in 100.
Without heart disease, NICE says offer a statin at a QRISK score of 10% or more, after lifestyle changes and a fresh risk check.
QRISK isn’t used if you have type 1 diabetes, kidney disease or inherited high cholesterol (familial hypercholesterolaemia). NICE counts you as high risk.
Under 10%? NICE says don’t rule one out if you’d prefer one after talking it through, or your score may be too low.
Had a heart attack or stroke? NICE says don’t delay a statin.
None apply? Ask your GP for your QRISK score and find the nearest figure.
Do statins cause side effects?
Yes, in some people. But most aches people get on a statin aren’t caused by it.
In 19 large trials, nobody knew who had the real tablet. Muscle pain or weakness came up in 27.1% on a statin and 26.6% on a dummy tablet. Over 90% of muscle reports on a statin were not due to the statin.
Source: NICE decision aid
Most new diabetes on a statin is in people whose blood sugar was already close to the diabetes level.
Severe muscle damage is rare. On a statin, about 3 extra people in 10,000 get it. NICE found no good evidence that statins cause dementia.
Got aches? Talk to your doctor. They may try another statin or change your dose.
Never stop or change a prescribed medicine without your prescriber. More in statins and muscle aches.
Is the cholesterol myth true?
No. A European expert panel pooled over 200 studies and trials, with more than 2 million people. It found the evidence “unequivocally establishes” that LDL causes artery disease.
Some of the best proof comes from genes. People born with rare genes that raise LDL get more heart disease. Rare genes that lower it go with less.
Genes are handed out at random, so this works like a trial nature runs from birth.
The risk seems to grow the higher your LDL is and the longer you’ve had it. See what your LDL result means and how to read your cholesterol results.
Can I say no to a statin?
Yes. If you don’t have heart disease, NICE says the decision comes after an informed talk about risks and benefits. Its decision aid says “It’s your choice”, and you can change your mind later.
If you don’t have heart disease, you can stop whenever you want, but the benefits stop too. The NHS says to talk to a doctor or pharmacist before stopping.
Before you decide on a statin
- If you don’t have type 1 diabetes, kidney disease or familial hypercholesterolaemia, ask your GP for your QRISK score.
- Find the NICE figure for the QRISK score nearest yours.
- Ask whether lifestyle changes alone could bring your score down, and when it will be checked again.
- Tell your GP about other medicines you take and any other health conditions.
- If you start one, expect blood tests before you start, again at 2 to 3 months, and a liver check at 12 months.
- If aches or other problems start, ask your doctor about another statin or dose before stopping.
Sources: NICE decision aid; NICE NG238; NHS
Can’t take a statin? The NHS lists other medicines, such as ezetimibe tablets and injections like inclisiran.
For food and exercise changes, see how to lower cholesterol. For the checks on a statin, see blood tests on statins.
When to speak to a GP
Book an appointment if:
- You’ve been offered a statin and want to talk through your risk first.
- You think a statin is causing side effects. Your doctor can check the cause.
- You want to stop or change your statin.
- You take a statin and are pregnant, trying to get pregnant, or could get pregnant and aren’t using contraception. The NHS says not to take them then.
Call NHS 111 if you think you’re having a serious side effect. For atorvastatin, the NHS lists:
- muscle cramps, severe pain and weakness, maybe with a high temperature and red or brown pee
- yellow skin or yellow whites of the eyes
- severe stomach pain
- a swollen throat or tongue, a raised itchy rash or trouble breathing
Call 999 for chest pain that feels tight or squeezing, or spreads to your arms, neck or jaw. Also call for severe trouble breathing, pale, blue or grey lips or skin, or someone who has passed out.