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New study finds millions more may need statins—but you may not be one of them

Four questions to ask before you start a cholesterol-lowering drug

Published: March 21, 2014 05:00 PM

Nearly 13 million more Americans are eligible for cholesterol-lowering statin drugs under new guidelines, according to a recent analysis in the New England Journal of Medicine.

That could prevent an additional 475,000 heart attacks and strokes over a 10-year period, the researchers say—but nearly every man between the age of 60 and 75, and more than half of women in that age group would need to take a statin. But do you need to?

Here are four questions to consider before you make that decision:

1. What’s your risk of having a heart attack or stroke?

 

For those who don’t have current or past heart disease, the new guidelines, from the American College of Cardiology and American Heart Association, consider your overall risk of having a heart attack or stroke in the next 10 years as the basis for a treatment decision. That is based on not just your cholesterol levels, but other factors too, including your age, blood pressure, gender, race, whether you smoke, or have diabetes. You can estimate your risk using this new calculator.

 

If you calculate that your risk is 7.5 percent or higher, the new guidelines say you should take a statin. But our medical consultants advise raising that bar a bit so that if your risk falls between 7.5 and less than 10 percent you might consider a statin, but for many, diet and lifestyle changes might be a better first step. Those changes, over a period of time, could lower your risk enough that you are no longer considered a candidate for a statin. 

2. How much will a statin actually lower your risk?

 

If your risk is in that gray zone between 7.5 percent and under 10 percent, use the calculator to see how changing it could affect your risk. For example, see if reducing your cholesterol level by one-third or a half makes a big change in your risk percent, or does it stay about the same? For some, it’s possible that taking a statin to lower your cholesterol won’t make a major difference in your 10-year risk. Or, you may find that you are comfortable with a certain risk level without treatment. 

3. Would lifestyle changes be enough?

 

Getting regular exercise, eating a healthy diet, losing weight, and quitting smoking, can noticeably reduce your 10-year risk of a heart attack or stroke. Some of those steps could reduce both your cholesterol and blood pressure, and raise your HDL (or “good” cholesterol) levels. Quitting smoking alone could reduce your risk substantially. Consider your blood pressure, too. Lowering it, for example, could reduce your overall risk enough so that no other action is needed. If you calculate your risk and find it’s below 10 percent, making a strong commitment to one or more of those changes may be an option to try before starting medication. 

4. What are the side effects of statins?

 

Our medical consultants also note that statins are notorious for causing minor aches and pains but can also cause rare but serious side effects, such as muscle breakdown (called rhabdomyolysis) that can lead to permanent kidney damage, coma, and possibly death. That’s especially true for higher doses. So if you do opt to take a statin, be alert for signs of any muscle problems: unexplained muscle weakness or pain, especially in your legs, fatigue even though you’ve slept well, stomach pain, and brown- or dark-colored urine. Consult your doctor immediately if you have any of those symptoms. 

For more details about how well statin drugs work, their side effects and how much they cost, read our latest, free Best Buy Drugs report on statin medications.

 

—Steve Mitchell

Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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