How to control your cholesterol and when to consider statins (2023)



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At times, it seems that half of the US population is on medication for high cholesterol. About 40 million Americans take statins, such as atorvastatin (Lipitor and Generic), lovastatin (Altoprev), and simvastatin (Zocor), which are by far the most commonly prescribed cholesterol medications.

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Statins can be quite effective. They can lower LDL ("bad") cholesterol by up to 25 to 55 percent, lower blood fats called triglycerides, and suppress inflammation -- and they can prevent heart attacks and strokes.

But there can be some confusion about when to start taking statins, especially in the elderly. While we are more prone to heart attacks and strokes as we age, the data showing that statins reduce this risk is "most evident in adults over 70 and less evident in adults over 80," says Daniel Forman, chair of the geriatrics division of the cardiology section at the University of Pittsburgh Medical Center. Concerns about the side effects of statins also increase with age, he says.


(Video) High Cholesterol - Do I Need To Take Medication?

Last year, the United States Preventive Services Task Forceconfirmed againthat there is insufficient evidence to recommend – or advise against – starting statin use in people aged 76 and older to prevent a first heart attack or stroke. "The USPSTF isn't saying you shouldn't do it, there just isn't enough research to say definitely that you should," said Robert Rosenson, director of cardiometabolic disorders at the Icahn School of Medicine in Mount Sinai, New York. .

The ideal cholesterol level for you — and whether you rely solely on lifestyle measures or take medication to achieve it — has to be personal, says Ardeshir Hashmi, chief of the Center for Geriatric Medicine at the Cleveland Clinic. “We no longer make automatic recommendations based on age,” he says. Therefore, it is advisable to talk to your doctor about your overall health goals and preferences, as well as the scientific evidence. Here is a summary of cholesterol related problems.

What are healthy levels for people in their 70s and 80s?

The numbers doctors usually look for are as follows.


  • Total Colesterol:less than 200 milligrams per deciliter (mg/dl). Cholesterol between 200 and 239 mg/dL is considered borderline; 240 mg/dL or more is high.
  • LDL ("regular") cholesterol:below 100 mg/dL. "If you already have heart disease, your doctors will want your LDL to stay below 70," says Michael Nanna, an interventional cardiologist at the Yale School of Medicine in New Haven, Connecticut.
  • HDL ("good") cholesterol:at least 40 mg/dL, with 60 mg/dL or more considered excellent.
  • Triglycerides (which are associated with an increased risk of heart disease):Less than 150 mg/dL is considered to be within the normal range, and 150 to 499 mg/dL is considered mildly elevated; 500 to 886 mg/dL, moderately elevated; and above 886 mg/dL, too high.
(Video) Statins and Cholesterol

Who should start taking medication?

If you are under 75 and have high LDL cholesterol or an increased risk of heart attack and stroke (due to a combination of risk factors), groups such as the American Heart Association recommend a statin to help reduce your risk of heart attack and stroke. . decrease. This is recommended whether you have heart disease or not.

The same goes for people over 75 diagnosed with heart disease, says Nanna: "We know that if you've been diagnosed with heart disease, the evidence is very clear that you should be taking [statins], including people aged 75 or over. more older Astudy published in the Lancet in 2019found, for example, that statin therapy for people with existing heart disease reduces the risk of a heart attack or stroke across all age groups.

What if I'm over 75 and don't have heart disease?

As with other age groups, talking to your doctor is essential. "If you have other risk factors, such as type 2 diabetes or an inflammatory condition such as rheumatoid arthritis, you fall into the higher-risk category, and statins may be something you should consider with your doctor," says Rosenson.


Some studies suggest that statin use may be beneficial in this age group, e.gstudy published in 2020 in JAMAnearly 327,000 veterans aged 75 and over. None of them had been diagnosed with heart disease at the start of the study. Veterans who started taking statins in the average seven years observed by the researchers were 20% less likely to die from heart disease than those who did not take statins.

If you're in doubt, you can ask your doctor for tests that reveal your cardiac calcification score, says George Fernaine, chief of cardiology at NYU Langone Hospital-Brooklyn in New York City. The higher the score, the more likely it is that atherosclerotic plaque will develop in the arteries of the heart, "which would indicate a stricter diet, exercise, or possibly the addition of medications."

I started with a statin, but it's not enough. And now?

Depending on your medical condition and response to medication, it may be wise to increase your dose. However, keep in mind that the side effects of statins may be more pronounced in older people who take the highest doses, Rosenson says. Hashmi says anyone over the age of 65 should start with the lowest possible dose, in part because "their bodies are less able to metabolize drugs." Another option if a statin isn't working well enough or the side effects are bothersome is to try a different statin, Hashmi adds.


(Video) Statins to lower cholesterol might not help heart health

For those at very high risk for cardiovascular disease, the American College of Cardiology and the American Heart Association say it's prudent to add ezetimibe (Zetia), which reduces cholesterol absorption. If that doesn't work, your doctor may recommend an injectable drug to lower your LDL levels. These include alirocumab (Praluent), evolocumab (Repatha, Repatha SureClick), and inclisiran (Lequio). Another non-statin option is bempedoic acid (Nexletol), which reduces the amount of cholesterol produced by the liver.

Reduce the side effects of statins

About 10 to 15 percent of people experience side effects such as muscle pain and muscle weakness. Research indicates that this is usually due to the "nocebo" effect: when negative effects occur because they are expected to result from negative beliefs, expectations, or experiences related to treatment.


Exercise can help: In one study, three sessions of about an hour per week significantly reduced the side effects of statins.

(Video) Study Confirms What Many Patients Taking Statins Have Said for Years | NBC Nightly News

A review of 12 studies suggests thisSupplement with coenzyme Q10s can also help. But they can interfere with certain medications, so check with your doctor, says Nieca Goldberg, clinical professor of medicine at NYU Grossman School of Medicine.

If these strategies don't work, talk to your doctor about a possible change, such as taking the drug every other day or switching to a different drug.

Lifestyle steps that work

  • Eat a heart-healthy diet:Aa diet rich in whole grains, vegetables, seafood, beans and nutsis perfect, says Hashmi. Regular consumption of unsaturated fats (olive oil, avocados, nuts, seeds) and soluble fiber (oats, barley, psyllium) can lower LDL cholesterol by about 7 to 15 mg/dl. Limit full-fat dairy, red meat, and fried foods, as saturated fat can raise LDL levels, says Donald Lloyd-Jones, head of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. High triglycerides? Look at refined carbohydrates. "Foods like white rice, bread and pasta, as well as sweets raise triglyceride levels," says Hashmi.
  • Do physical activity:The AHA recommends at least 150 minutes of moderate-intensity exercise (brisk walking, swimming, cycling) per week to lower cholesterol. This is especially important if you're trying to raise HDL levels, as no drug does it safely, says Lloyd-Jones.
  • Make other healthy choices:Quit smoking, lose weight and drink alcohol only in moderation.

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(Video) Alternatives to statin medications that help lower cholesterol without side effects


At what cholesterol level should statins be considered? ›

If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L). If your risk is very high — for example, you've had a heart attack in the past — a statin may be helpful even if you don't have high cholesterol.

How do you decide if I should take statins? ›

If your 10-year risk of having a heart attack or stroke is greater than 10 per cent, you will be asked to consider taking a statin. Most doctors also recommend statins for people who have diabetes. The risks, as with all medicines, include possible side effects.

Can a person with high cholesterol reverse it without statins? ›

Most people can lower high cholesterol with lifestyle changes, like prioritizing heart-healthy foods, quitting tobacco products, exercising regularly, and sleeping enough. Making changes to lower your cholesterol might mean you don't need to take cholesterol medication anymore (or deal with the side effects).

At what point do doctors recommend statins? ›

Your doctor may recommend taking statins if either: you've been diagnosed with a form of CVD. your personal and family medical history suggests you're likely to develop CVD at some point over the next 10 years and lifestyle measures (see below) haven't reduced this risk.

At what triglycerides level should you start statins? ›

HMG-CoA reductase inhibitors (statins)

Maximum doses of the strongest statins, atorvastatin, simvastatin, and rosuvastatin, lower triglycerides approximately 40%, but such doses are not appropriate first-line therapy unless triglycerides are less than 500 mg/dL and LDL-C is elevated.

What is the downside of statins? ›

While statins are highly effective and safe for most people, they have been linked to muscle pain, digestive problems and mental fuzziness in some people. Rarely, they may cause liver damage.

Can you get off statins once you start? ›

If you're taking a statin medication to lower your cholesterol, you will need to keep taking your prescription, or your cholesterol will likely go back up. Stopping your statin can put you at risk of having heart disease and other preventable health problems like stroke and heart attack from high cholesterol.

What is the new alternative to statins? ›

People who are unwilling or unable to take statins have limited options for other cholesterol-lowering medications. One possible choice is bempedoic acid, which was approved by the U.S. Food and Drug Administration (FDA) in 2020.

What is the safest statin to take for high cholesterol? ›

According to a research review people who take simvastatin (Zocor) or pravastatin (Pravachol) may experience fewer side effects.

Why do people not want to take statins? ›

Fear of side effects and perceived side effects are the most common reasons for declining or discontinuing statin therapy. Willingness to take a statin is high, among both patients who have declined statin therapy and those who have never been offered one.

Is there a healthy alternative to statins? ›

Statin alternatives include some prescription medications like ezetimibe and fibric acids. Natural remedies that some people use to help treat high cholesterol include omega-3 fatty acids and red yeast rice extract. Before stopping a statin medication and trying an alternative, speak to a doctor or pharmacist.

What vitamins should not be taken with statins? ›

Certain herbal supplements, such as St. John's wort and possibly quercetin, may decrease blood levels of some statin drugs, and when taken with atorvastatin, may actually result in increased cholesterol levels. Certain forms of magnesium may also decrease blood levels of statin drugs -- particularly Crestor.

Which statin is safest for liver? ›

Specifically, lipophilic statins (those that dissolve more readily in lipids such as oils and fats) may be more effective for preventing liver cancer than hydrophilic statins (those that dissolve more readily in water).

Can statins cause weight gain? ›

Statin use is associated with increased calorie intake and consequent weight gain. It is speculated that statin‐dependent improvements in lipid profile may undermine the perceived need to follow lipid‐lowering and other dietary recommendations leading consequently to increased calorie intake.

How long does it take for statins to reduce plaque? ›

Initial magnetic resonance imaging (MRI) studies of the aorta suggested that statin use might result in atherosclerotic plaque regression as early as 6 months after initiation of therapy [2].

How long does it take for oatmeal to lower cholesterol? ›

How quickly does oatmeal lower cholesterol? Current evidence suggests daily oatmeal intake can lower cholesterol in five to six weeks. [10] However, some studies report significant declines in total and LDL cholesterol in as short as four weeks.

How high is LDL to start statins? ›

LDL-C >160 mg/dL (>4.14 mmol/L) – In patients with LDL-C levels >160 mg/dL and a calculated 10-year atherosclerotic CVD (ASCVD) risk of 5 to 10 percent, we usually suggest statin therapy.

How quickly does cholesterol rise after stopping statin? ›

How long does it take for statins to get out of your system? It can take a few months for your cholesterol levels to return to what they were prior to the medication. Side effects will generally disappear a few weeks after your last dose.

Why are statins banned in Europe? ›

Joseph A. Hill, M.D., Ph. D. The controversy in the United Kingdom started in 2013 when the British Medical Journal (BMJ) claimed statins were being overprescribed to people with low risk of heart disease, and that the drugs' side effects were worse than previously thought.

At what age should statins be stopped? ›

Do not start a statin in patients ages ≥ 75 years who do not have known vascular disease or type 2 diabetes; start or continue a statin in all patients ages 75 to 84 with type 2 diabetes to prevent cardiovascular events and mortality; and start or continue a statin in patients ages > 75 years who have known vascular ...

Can you quit statins cold turkey? ›

It's important to know that stopping statins cold turkey, or even gradually, can cause serious health problems and you should talk to your doctor before doing so.

Are statins worth the risk? ›

And so, in general, although there are some potential side effects long-term for statins, in most cases, if your doctor has identified you as having high cholesterol and needing a statin, the risks greatly outweigh, or sorry, the benefits greatly outweigh the risks.

What is the safest statin on the market? ›

A low-dose statin like atorvastatin (Lipitor®) is safe for most patients, including those with mild liver enzyme abnormalities.

Which statin is safest for kidneys? ›

We showed that fluvastatin 20 mg/ezetimibe 10 mg was the most efficacious treatment regarding both renal outcomes.

What is the first drug of choice for cholesterol? ›

Statins are the most common medicine for high cholesterol. They reduce the amount of cholesterol your body makes. You take a tablet once a day. You usually need to take them for life.

What is the new treatment for high cholesterol? ›

A newer drug called Nexletol was approved in 2020 by the FDA to treat high cholesterol, but the new study published in NEJM shows that the drug also reduces the risk of heart disease. Researchers believe this data supports using Nexletol as a safe and effective alternative for many people who cannot take statins.

What happens if you don't take CoQ10 with statins? ›

Some studies have shown that statins decrease the concentration of CoQ10 in both muscle tissue and in the bloodstream. The hypothesis is that, if you decrease the CoQ10 levels, you reduce the production of energy in muscle cells and they won't function as well, leading to muscle aches, weakness or inflammation.

Do doctors get kickbacks for prescribing statins? ›

Ornstein continued, "It's illegal to give kickbacks to a doctor to prescribe drugs, but it is legal to give money to doctors to help promote your drug. Some doctors make tens of thousands or hundreds of thousands of dollars a year beyond their normal practice just for working with the industry."

How many people refuse to take statins? ›

The study found that while about two-thirds of the patients who were being recommended statin therapy eventually tried it, about one-third never did.

What is the average age to start taking statins? ›

The average age at which patients started on statins was 62; nearly half (48.5%) of them were women. All had started treatment between 1990 and 2016. Any reduction in cholesterol below 40 per cent after two years of statin treatment was deemed to be a 'suboptimal' response.

Is garlic better than statins? ›

Nothing in the current research suggests that garlic is anywhere near as effective as statin drugs in treating high cholesterol. As promising as some of the evidence may sound, self-treating a condition like high cholesterol is likely to cause more harm than good.

What is the new cholesterol medication for 2023? ›

By Lauran Neergaard • Published March 6, 2023

shows the cholesterol-lowering drug Nexletol made by Esperion Therapeutics Inc. Drugs known as statins are the first-choice treatment for high cholesterol but millions of people who can't or won't take those pills because of side effects may have another option.

What lowers cholesterol naturally? ›

Oatmeal, oat bran and high-fiber foods

Soluble fiber is also found in such foods as kidney beans, Brussels sprouts, apples and pears. Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your LDL cholesterol.

What numbers are needed to treat statins? ›

Statins, which have become synonymous with “heart-attack-and-stroke-preventing,” have an NNT of 60 for heart attack and 268 for stroke: That's how many healthy people have to take statins for five years for those respective outcomes to be prevented.

Should I take a statin if my LDL is 160? ›

An LDL level of 160 is high, but 190 is considered very high. For someone taking a statin, the risk for a heart attack or stroke drops by about 20% for each 39-point reduction in bad cholesterol. Under the new guidelines, anyone 21 or older with an LDL level of 190 or higher should take a statin drug.

What are the LDL guidelines for 2023? ›

New 2023 hypertension and lipid targets

For low-density lipoprotein (LDL) cholesterol levels in patients with diabetes, the ADA recommends now a target of less than 70 mg/dL or no greater than 55 mg/dL, depending on the individual's cardiovascular risk. The 2023 standards also have new therapeutic lipid targets.

How bad is 190 LDL cholesterol? ›

An LDL (bad cholesterol) level of 190 or above is considered a serious risk factor for heart attack, stroke, and other problems caused by clogged arteries.

What is the rule of 6 for statins? ›

The rule of 6 is that when we double the dose of a statin, we only get another 6% LDL lowering.

What is the safest statin? ›

A low-dose statin like atorvastatin (Lipitor®) is safe for most patients, including those with mild liver enzyme abnormalities. Many people have fatty liver disease due to obesity.

Is there a better solution than statins? ›

Ezetimibe. Ezetimibe is a tablet that lowers cholesterol. It may be prescribed if statins cannot be taken, or alongside a statin for extra cholesterol-lowering. It's a 'cholesterol absorption inhibitor' that limits the absorption of cholesterol in the small intestine.

Do statins make you gain weight? ›

Statin use is associated with increased calorie intake and consequent weight gain. It is speculated that statin‐dependent improvements in lipid profile may undermine the perceived need to follow lipid‐lowering and other dietary recommendations leading consequently to increased calorie intake.


(Erik Richardson D.O.)
2. What You Should Know Before Saying 'Yes' to Cholesterol-Lowering Statin Drugs
(CBN News)
3. Mayo Clinic Minute: Should You Take Statins?
(Mayo Clinic)
4. How to Lower Your Cholesterol | Leslie Cho, MD
(Cleveland Clinic)
5. Doctor explains how to take cholesterol lowering drug ATORVASTATIN (Lipitor) + doses, side effects!
(Doctor O'Donovan)
6. 5 Foods That Can Help Lower Cholesterol: Apples, Lentils, Avocados | TODAY


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