Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

British Columbia Specific Information

What you eat is important to the health of your heart. Heart healthy eating can help you prevent and/or manage high blood pressure, high cholesterol, or heart failure. For information on heart healthy eating and nutrition, see Healthy Eating – Heart Health. You may also call 8-1-1 to speak to a registered dietitian, Monday to Friday 9:00 a.m. to 5:00 p.m., or you can Email a HealthLinkBC Dietitian.

For additional information on heart healthy eating and living, visit the BC Heart and Stroke Foundation.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Start taking a medicine called a statin to help prevent coronary artery disease and lower your risk of heart attack and stroke.
Don't take a statin. Try to lower your risk with healthy lifestyle habits alone.

Is this decision for you? This could be a decision for you if you do not have coronary artery disease and have not had a heart attack or a stroke. If you have been diagnosed with coronary artery disease or peripheral arterial disease (PAD) or if you have had a heart attack or a stroke, this information is not for you. Statins are strongly recommended for people with these conditions.

Key points to remember

Statins can help prevent coronary artery disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.
If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.
You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.
Some people who take statins have side effects.
A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.

FAQs

How can you know your risk of heart attack and stroke?

Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:

Your cholesterol numbers.
Your blood pressure.
Whether you have diabetes.
Your age, gender, and race.
Whether you smoke.

Your doctor might talk about your risk of having a heart attack or a stroke in the next 10 years. There are different online tools that doctors can use to calculate this risk. These tools are not perfect. They may show that your risk is higher or lower than it really is. But the tools can give you and your doctor a good idea about your risk.

Why might your doctor recommend taking a statin?

Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.

If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of coronary artery disease, to decide if medicine may be right for you.

In general:

People at high risk will get more benefit from taking a statin than those at low risk.
People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.

What is a heart-healthy lifestyle?

Everyone can help lower their risk of a heart attack or stroke with a heart-healthy lifestyle. This includes:

Eating vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
Being active on most days of the week. To lower risk, try to do moderate to vigorous activity at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
Losing weight if you need to, and staying at a healthy weight.
Not smoking.
Managing other health problems. These include diabetes and high blood pressure.

A heart-healthy lifestyle is important whether you take statins or not. Medicines don't take the place of healthy habits.

How do statins work?

Statins lower the amount of bad (LDL) cholesterol in your blood.

Cholesterol is a type of fat in your blood. Your body needs it for many things, such as making new cells. But if you have too much cholesterol, it starts to build up in blood vessels called arteries. This problem is called atherosclerosis. It is the starting point for most heart and blood flow problems, including heart attacks and strokes.

Statins lower bad cholesterol by reducing how much of it your body makes. Statins also decrease inflammation around the cholesterol buildup (called a plaque). This may lower the risk that the plaque will break apart and cause a blood clot that can lead to a heart attack or stroke.

What are the side effects of statins?

Some people who take statins report that they have more muscle aches. But it's not clear whether these are actually a side effect of statins.^{footnote 1}

A less common issue is diabetes. Statins may slightly raise the risk of diabetes in some people. This risk seems to be sightly higher in people who already have risk factors for getting diabetes.

The decision to take a statin is up to you. You can try it, and if you don't like the way it makes you feel, you can talk with your doctor. You may choose to take a different statin or a different dose to try to avoid side effects.

What do numbers tell us about benefits and risks of statins?

Benefits

Number of people who will have a heart attack or stroke in the next 10 years by risk level*
Risk of heart attack or stroke	With statins	Without statins
Low risk	2 out of 100	3 out of 100
Moderate risk	8 out of 100	10 out of 100
High risk	15 out of 100	20 out of 100

* These numbers are estimates based on research studies. The quality of the evidence is high.^{footnote 2, footnote 3}

Evidence shows that statins may lower the chance of having a heart attack or stroke, especially for people who are at high risk.

Take a group of 100 people with alowrisk of heart attack or stroke. Here are their chances of having one in the next 10 years:^{footnote 2, footnote 3}

If they don't take statins, about 3 out of 100 will have a heart attack or stroke. This means that about 97 out of 100 won't.
If they do take statins, about 2 out of 100 will have a heart attack or stroke. This means that about 98 out of 100 won't.

Take a group 100 people with amoderaterisk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:

If they don't take statins, about 10 out of 100 will have a heart attack or stroke. This means that about 90 out of 100 won't.
If they do take statins, about 8 out of 100 will have a heart attack or stroke. This means that about 92 out of 100 won't.

Take a group of 100 people with ahighrisk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:

If they don't take statins, about 20 out of 100 will have a heart attack or stroke. This means that about 80 out of 100 won't.
If they do take statins, about 15 out of 100 will have a heart attack or stroke. This means that about 85 out of 100 won't.

Risks

Risk of muscle aches

More research is being done to better understand the chances of having muscle problems from taking statins. Some people who take statins report that they have more muscle aches. But it's not clear how often these are actually a side effect of statins.^{footnote 1}

Risk of diabetes

Number of people who will get diabetes in the next 4 years
Risk	With statins	Without statins
Getting diabetes	5 out of 100	4 to 5 out of 100

* These numbers are estimates based on research studies.^{footnote 4}

Evidence shows that statins may raise the risk of diabetes in some people. The quality of this evidence is moderate. This risk seems to be slightly higher in people who already have risk factors for getting diabetes.

Take a group of 100 people. Here are their chances of getting diabetes in the next 4 years:^{footnote 4}

With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.
Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.^{footnote 2, footnote 5, footnote 4, footnote 3}

The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Take statins to lower your risk of heart attack or stroke
Take statins to lower your risk of heart attack or stroke

You take a pill every day.
You also have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.

Studies show that statins can lower the risk of heart attack and stroke.
Statins provide the most benefit for people at high risk of heart attack and stroke.

Some people who take statins report that they have more muscle aches. It's not clear whether these are actually a side effect of statins.
Statins may slightly increase the risk of diabetes.

Don't take statins
Don't take statins

You have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.

Healthy habits alone can help lower your risk of heart attack and stroke without the possible side effects of medicine.
You avoid the bother and cost of taking a pill every day.

Healthy habits alone may not lower your risk as much as healthy habits plus a statin would.

Stories about deciding whether to take a statin to lower heart attack and stroke risk

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight.

Becky, age 56

My cholesterol is high, but I really don't like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good.

Diego, age 41

My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine.

Charles, age 48

I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk.

Carole, age 58

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.

I'm not very worried about my risk of heart attack and stroke.

More important

Equally important

More important

I don't mind taking medicine if it will reduce my risk of heart attack and stroke.

I hate the idea of taking a pill every day.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

I'm already doing everything I can to reduce my risk through heart-healthy habits.

I could do more to reduce my risk by improving my habits.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Michael P. Pignone MD, MPH, FACP - Internal Medicine
Primary Medical Reviewer	JoLynn Montgomery PA - Family Medicine & Heather Quinn MD - Family Medicine

References

Citations

Newman CB, et al. (2019). Statin safety and associated adverse events: A scientific statement from the American Heart Association. Atherosclerosis, Thrombosis, and Vascular Biology, 39(2): e38–e81. DOI: 10.1161/ATV.0000000000000073. Accessed October 16, 2020.
Taylor F, et al. (2013). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (1): 1–96. DOI: 10.1002/14651858.CD004816.pub5. Accessed January 8, 2014.
Yusuf S, et al. (2016). Cholesterol lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine, 374: 2021–2031. DOI: 10.1056/NEJMoa1600176. Accessed May 27, 2016.
Sattar N, et al. (2010). Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet, 375(9716): 735–742.
Joy T, et al. (2009). Narrative review: Statin-related myopathy. Annals of Internal Medicine, 150(12): 858–868. DOI: 10.7326/0003-4819-150-12-200906160-00009. Accessed April 7, 2015.

Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Start taking a medicine called a statin to help prevent coronary artery disease and lower your risk of heart attack and stroke.
Don't take a statin. Try to lower your risk with healthy lifestyle habits alone.

Key points to remember

Statins can help prevent coronary artery disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.
If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.
You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.
Some people who take statins have side effects.
A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.

FAQs

How can you know your risk of heart attack and stroke?

Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:

Your cholesterol numbers.
Your blood pressure.
Whether you have diabetes.
Your age, gender, and race.
Whether you smoke.

Why might your doctor recommend taking a statin?

Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.

In general:

People at high risk will get more benefit from taking a statin than those at low risk.
People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.

What is a heart-healthy lifestyle?

Everyone can help lower their risk of a heart attack or stroke with a heart-healthy lifestyle. This includes:

Eating vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
Being active on most days of the week. To lower risk, try to do moderate to vigorous activity at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
Losing weight if you need to, and staying at a healthy weight.
Not smoking.
Managing other health problems. These include diabetes and high blood pressure.

A heart-healthy lifestyle is important whether you take statins or not. Medicines don't take the place of healthy habits.

How do statins work?

Statins lower the amount of bad (LDL) cholesterol in your blood.

What are the side effects of statins?

Some people who take statins report that they have more muscle aches. But it's not clear whether these are actually a side effect of statins.¹

A less common issue is diabetes. Statins may slightly raise the risk of diabetes in some people. This risk seems to be sightly higher in people who already have risk factors for getting diabetes.

What do numbers tell us about benefits and risks of statins?

Benefits

Number of people who will have a heart attack or stroke in the next 10 years by risk level*
Risk of heart attack or stroke	With statins	Without statins
Low risk	2 out of 100	3 out of 100
Moderate risk	8 out of 100	10 out of 100
High risk	15 out of 100	20 out of 100

* These numbers are estimates based on research studies. The quality of the evidence is high.^{2, 3}

Evidence shows that statins may lower the chance of having a heart attack or stroke, especially for people who are at high risk.

Take a group of 100 people with alowrisk of heart attack or stroke. Here are their chances of having one in the next 10 years:^{2, 3}

If they don't take statins, about 3 out of 100 will have a heart attack or stroke. This means that about 97 out of 100 won't.
If they do take statins, about 2 out of 100 will have a heart attack or stroke. This means that about 98 out of 100 won't.

Take a group 100 people with amoderaterisk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:

If they don't take statins, about 10 out of 100 will have a heart attack or stroke. This means that about 90 out of 100 won't.
If they do take statins, about 8 out of 100 will have a heart attack or stroke. This means that about 92 out of 100 won't.

Take a group of 100 people with ahighrisk of heart attack or stroke. Here are their chances of having a heart attack or stroke in the next 10 years:

If they don't take statins, about 20 out of 100 will have a heart attack or stroke. This means that about 80 out of 100 won't.
If they do take statins, about 15 out of 100 will have a heart attack or stroke. This means that about 85 out of 100 won't.

Risks

Risk of muscle aches

Risk of diabetes

Number of people who will get diabetes in the next 4 years
Risk	With statins	Without statins
Getting diabetes	5 out of 100	4 to 5 out of 100

* These numbers are estimates based on research studies.⁴

Take a group of 100 people . Here are their chances of getting diabetes in the next 4 years:⁴

With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.
Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.

Understanding the evidence

The information shown here is based on the best available evidence.^{2, 5, 4, 3}

The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

2. Compare your options

	Take statins to lower your risk of heart attack or stroke	Don't take statins
What is usually involved?	You take a pill every day. You also have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.	You have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, managing other health problems, and not smoking.
What are the benefits?	Studies show that statins can lower the risk of heart attack and stroke. Statins provide the most benefit for people at high risk of heart attack and stroke.	Healthy habits alone can help lower your risk of heart attack and stroke without the possible side effects of medicine. You avoid the bother and cost of taking a pill every day.
What are the risks and side effects?	Some people who take statins report that they have more muscle aches. It's not clear whether these are actually a side effect of statins. Statins may slightly increase the risk of diabetes.	Healthy habits alone may not lower your risk as much as healthy habits plus a statin would.

Personal stories

Stories about deciding whether to take a statin to lower heart attack and stroke risk

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight."

— Becky, age 56

"My cholesterol is high, but I really don't like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good."

— Diego, age 41

"My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine."

— Charles, age 48

"I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk."

— Carole, age 58

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.

I'm not very worried about my risk of heart attack and stroke.

More important

Equally important

More important

I don't mind taking medicine if it will reduce my risk of heart attack and stroke.

I hate the idea of taking a pill every day.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

I'm already doing everything I can to reduce my risk through heart-healthy habits.

I could do more to reduce my risk by improving my habits.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Michael P. Pignone MD, MPH, FACP - Internal Medicine
Primary Medical Reviewer	JoLynn Montgomery PA - Family Medicine & Heather Quinn MD - Family Medicine

References

Citations

Newman CB, et al. (2019). Statin safety and associated adverse events: A scientific statement from the American Heart Association. Atherosclerosis, Thrombosis, and Vascular Biology, 39(2): e38–e81. DOI: 10.1161/ATV.0000000000000073. Accessed October 16, 2020.
Taylor F, et al. (2013). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (1): 1–96. DOI: 10.1002/14651858.CD004816.pub5. Accessed January 8, 2014.
Yusuf S, et al. (2016). Cholesterol lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine, 374: 2021–2031. DOI: 10.1056/NEJMoa1600176. Accessed May 27, 2016.
Sattar N, et al. (2010). Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet, 375(9716): 735–742.
Joy T, et al. (2009). Narrative review: Statin-related myopathy. Annals of Internal Medicine, 150(12): 858–868. DOI: 10.7326/0003-4819-150-12-200906160-00009. Accessed April 7, 2015.

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