Should I Be on Statins for High Cholesterol

You’re sitting in your doctor’s office for a routine checkup, feeling fine. But your doctor recommends you start taking a statin.

You think: But I feel fine. Or maybe: I don't even eat much cholesterol.

"I do get that a lot," says Dr. Jacob Symington, a primary care physician at Houston Methodist. "But diet is only part of the story. And if your cholesterol is high, or if your 10-year risk of heart attack or stroke is high, you likely won't have symptoms until it's too late."

Understanding why your doctor is recommending a statin is an important first step in protecting both your heart and brain health.

What are statins?

Statins are medications that decrease the synthesis — or production — of cholesterol in your liver. When the liver makes less cholesterol, the overall level of cholesterol in your bloodstream drops.

Common statins include:

• Atorvastatin
• Rosuvastatin
• Simvastatin
• Pravastatin
• Lovastatin
  
  

Which one your doctor recommends depends on your personal cardiovascular risk, your cholesterol levels and how you tolerate the medication.

Understanding high cholesterol and your heart disease risk

Many people assume high cholesterol comes from eating too much cholesterol itself — but that’s not actually the case.

“It’s more about the carbohydrates we eat," explains Dr. Symington. "Sugary foods, simple carbs — these are eventually converted into cholesterol once broken down in the body.”

Factors that can increase cholesterol levels and heart disease risk include:

• A diet high in ultra-processed foods
• Too little physical activity
• Being overweight
• Smoking
• Increasing age
  
  

Even though you don't feel the effects, over time these lifestyle factors can lead to the formation of fatty deposits (called plaque) in your arteries. This buildup causes arteries to harden and narrow — called atherosclerosis — which can reduce blood flow. Left unchecked, atherosclerosis increases the risk of coronary artery disease and cerebral artery disease. Complications include heart attack and stroke.

"Atherosclerosis can also lead to peripheral artery disease, which can cause leg pain when walking," says Dr. Symington.

Who should consider statin therapy?

Deciding who needs a statin is based on a calculated 10‑year risk of developing atherosclerotic cardiovascular disease (ASCVD). This includes risk of heart attack, stroke and peripheral artery disease.

"This calculation takes into account cholesterol levels, blood pressure, whether you smoke, whether you have diabetes, your age and more," says Dr. Symington. "From this, it provides a percentage risk of heart attack or stroke over the next ten years.”

Statins are recommended when your calculated 10‑year ASCVD risk is higher than average.

"And if your LDL cholesterol is over 190, we automatically want you on a statin," adds Dr. Symington.

Benefits of statin therapy

The primary goal of statins is not just lowering cholesterol on a lab report — it’s preventing life‑threatening events.

“The big reason we use these medicines at all is to lower the risk of heart attack and stroke,” says Dr. Symington. “Over a period of 5, 10, 15 years, that risk is lowered considerably.”

In other words, being on a statin is essentially a long‑term investment in your heart health and brain health.

Your doctor can help you manage potential side effects of statins

Statins are generally very safe, but like any medication, they can have side effects. Dr. Symington highlights the most common concerns:

Muscle aches

There is a small increased risk of muscle pain, but most people do not experience serious muscle problems. If this side effect does arise, switching statins can help.

Liver enzyme elevations

Statins can cause mild, temporary bumps in liver enzymes, but liver damage is not significantly more common than in people not taking statins. And regular lab monitoring helps ensure safe use.

"The literature shows very clearly that the benefit of reduced heart attack and stroke risk outweighs any transient impact on the liver," reassures Dr. Symington.

Type 2 diabetes risk

“There is an increased risk of developing diabetes with statin medications," says Dr. Symington.

However, he stresses that this risk remains low, and the trade‑off still strongly favors treatment.

“The decreased risk of cardiovascular disease with statins outweighs the risk of developing diabetes because that risk is low — and you still see an overall decrease in cardiovascular disease and death from all causes despite the small risk of diabetes," reassures Dr. Symington.

When lifestyle changes alone are (and aren't) enough

Lifestyle always matters when it comes to lowering cholesterol levels — and sometimes behavioral changes can be tried first.

“Especially if cholesterol elevation is mild or heart attack-stroke risk isn’t high, your doctor may recommend first trying exercise and diet, before prescribing a statin," says Dr. Symington.

Lifestyle changes that can help lower cholesterol include:

• Getting 150 minutes of exercise per week
• Eating more whole foods and reducing intake of simple carbs, fried foods and saturated fats
• Maintaining a healthy weight
• Stopping smoking
  
  

(Related: 4 Tips to Make a Heart-Healthy Diet Taste Great)

Sometimes, these changes improve cholesterol enough. Other times, they’re not quite enough on their own.

“A lot of times the plan I come to with patients is: try this for three or six months. And if we don’t see things heading in the right direction, I’d like us to try a statin," adds Dr. Symington.

Making an informed decision about statin therapy

If your doctor recommends a statin, it’s not because your cholesterol is “a little high” — it’s because your long-term risk of heart attack or stroke can be significantly lowered by medication.

And you don’t have to choose between lifestyle changes and statins. As Dr. Symington emphasizes, they often work best together.

If you’re unsure, ask your doctor to walk you through your risk numbers and what they mean for your health. After all, the goal isn’t just good lab results — it’s protecting your future.