Statins are the most studied heart drugs in the world, and also some of the most argued about. They lower LDL cholesterol, they cut the risk of heart attack and stroke, and they have a reputation for side effects that is larger than the evidence supports. If your doctor has suggested one, you are probably weighing the benefits against what you have heard.
This guide sets out what statins do, how much they help, who current guidelines say should take one, what the side effects look like in blinded trials, and the common myths. It is not a case for or against. The decision depends on your own risk and is one to make with your doctor.
In this guide
What statins are and how they work
Statins block an enzyme in the liver called HMG-CoA reductase, which the liver uses to make cholesterol. When the liver makes less, it pulls more LDL cholesterol out of the blood to make up the difference. The result is a lower LDL level, and LDL is the main particle that builds plaque in artery walls.
Common statins include atorvastatin, rosuvastatin, simvastatin and pravastatin. They differ mainly in strength. Doctors group them by how much they lower LDL:
| Intensity | Typical LDL reduction | Examples |
|---|---|---|
| High intensity | 50% or more | Atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg |
| Moderate intensity | 30% to 49% | Atorvastatin 10 to 20 mg, rosuvastatin 5 to 10 mg, simvastatin 20 to 40 mg |
Statins do not replace diet and exercise, and they do not lower Lp(a), an inherited cholesterol particle covered in our Lp(a) test guide. What they do is lower LDL more reliably than any lifestyle change on its own.
How much statins help
The best evidence comes from the Cholesterol Treatment Trialists’ (CTT) Collaboration, which pools individual data from large randomised trials. Its 2010 analysis in the Lancet found that each 1 mmol/L reduction in LDL (about 39 mg/dL) cut the rate of major vascular events, such as heart attack, stroke and the need for a stent or bypass, by about a fifth. It also lowered death from any cause by about 10% per 1 mmol/L.
Two points make those numbers more useful:
- The bigger the LDL drop, the bigger the benefit. Lowering LDL by 2 mmol/L does more than lowering it by 1.
- Your absolute benefit depends on your starting risk. A fifth off a high risk is a large number of heart attacks avoided. A fifth off a very low risk is a small one. That is why guidelines tie statin decisions to your overall risk, not just your cholesterol.
Who should take statins
The 2026 ACC/AHA dyslipidemia guideline replaced the 2018 cholesterol guideline and uses the AHA’s PREVENT calculator to estimate 10-year risk. In broad terms, according to a University of Illinois Chicago summary of the guideline:
- Men who already have heart disease, such as a previous heart attack, stroke or stent, are recommended a high-intensity statin.
- Men with LDL of 190 mg/dL or higher are recommended the maximum tolerated statin, whatever their calculated risk.
- Men aged 40 to 75 with diabetes should receive a statin, with higher intensity if they have several risk factors.
- Men at high 10-year risk (10% or more) are recommended a high-intensity statin.
- Men at intermediate risk (5% to under 10%) are generally recommended a moderate- to high-intensity statin.
- Men at borderline risk (3% to under 5%) should look at risk enhancers, such as family history, a high Lp(a) or chronic inflammatory disease, before deciding.
For men in the borderline and intermediate groups who are unsure, a coronary calcium score can help settle the question. A score of zero can support waiting, while any calcium supports starting treatment. Our complete guide to heart health for men explains how the risk score works.
The guideline also brings back LDL goals: under 100 mg/dL for most people treated for prevention, under 70 mg/dL at high risk, and under 55 mg/dL for those with heart disease at very high risk.
What to expect when you start a statin
Most statins are a single tablet once a day. Starting one is usually simple, but a few steps help you get the most from it.
A follow-up blood test
The 2026 guideline advises a repeat lipid test 4 to 12 weeks after starting a statin or changing the dose, then every 6 to 12 months. That first check shows whether your LDL has fallen enough to reach your goal, and whether the dose needs adjusting.
Give it time, and keep notes
If you notice aches or other symptoms in the first weeks, write down when they started and what you were doing. Many aches have other causes, such as a new training plan, poor sleep or a viral illness. A clear record makes it easier for your doctor to work out whether the statin is to blame.
Questions to ask your doctor
- What is my 10-year risk, and how much would a statin lower it?
- What LDL goal are we aiming for, and how will we know if we get there?
- Would a coronary calcium score or an Lp(a) test change your advice?
- What should I do if I get side effects?
- Are any of my other medicines or supplements a problem with this statin?
That last question matters because some statins interact with other drugs. Your doctor or pharmacist can check your full list.
Statin side effects: what the trials show
Statins do have side effects. The question is how common they are, and the best answers come from trials where neither patients nor doctors knew who was taking the drug.
Muscle aches
Muscle pain is the side effect people worry about most. In 2022 the CTT Collaboration published an analysis in the Lancet of 19 double-blind trials of statin versus placebo, covering 123,940 people. Statins caused a small excess of muscle symptoms, mostly mild. The key finding: more than 90% of the muscle symptoms reported by people taking a statin were not caused by the statin, because people on placebo reported them at almost the same rate.
The nocebo effect
The SAMSON trial, published in the New England Journal of Medicine in 2020, tested this directly. It enrolled 60 people who had stopped statins because of side effects. Each took a statin for some months, a placebo for others and nothing for the rest, without knowing which was which. About 90% of the symptoms they felt on the statin also appeared on the placebo. After seeing their results, about half went back on a statin.
None of this means symptoms are imaginary. They are often felt, but the cause is often expectation rather than the drug. The CTT authors were clear that people with symptoms should not be dismissed.
Rare serious muscle damage
Severe muscle breakdown, called rhabdomyolysis, can occur but is rare. Unexplained severe muscle pain or weakness, especially with dark urine, needs prompt medical attention.
Blood sugar and diabetes
Statins slightly raise the chance of being diagnosed with type 2 diabetes. A 2010 Lancet meta-analysis by Sattar and colleagues pooled 13 trials with 91,140 people and found 9% higher odds of diabetes on a statin. In absolute terms, that worked out to about one extra case for every 255 people treated for four years. The authors judged this small next to the reduction in heart attacks and strokes.
Liver and memory
In 2012 the US Food and Drug Administration updated statin labels. It noted that serious liver injury is rare and dropped the advice for routine liver blood tests, recommending a test before starting and afterwards only if needed. It also added that some people have reported memory loss or confusion, which the FDA described as generally non-serious and reversible.
Five common myths about statins
“Most people get muscle pain on statins”
In blinded trials, the extra muscle symptoms caused by statins are small, and more than 90% of the symptoms people report would have happened anyway.
“Once my cholesterol is down, I can stop”
Statins work while you take them. If you stop, your LDL usually climbs back towards where it was. Any change should be discussed with your doctor first.
“Diet can do the same job”
Diet and exercise matter, and they improve far more than cholesterol. Our guide on how to lower cholesterol naturally covers what works. But for men who need a large LDL reduction, lifestyle changes on their own rarely reach the 50% drop a high-intensity statin can give.
“Statins are only for older men”
The 2026 guideline puts more weight on lowering LDL earlier, because lower LDL for longer gives more protection. Men in their 30s and 40s with very high LDL or a strong family history may be advised to start sooner.
“If I take a statin, I can eat what I like”
A statin lowers one risk factor. Blood pressure, smoking, weight and blood sugar still add to your risk. Our guide on how to lower blood pressure naturally is a good place to start on the next one.
If a statin does not suit you
If you get side effects, talk to your doctor before stopping. There are usually options:
- Switch to a different statin. Some people tolerate one better than another.
- Lower the dose or the frequency. The National Lipid Association has published guidance on low-dose and less-than-daily regimens for people who struggle with standard doses.
- Add or switch to a non-statin. The 2026 guideline lists ezetimibe, bempedoic acid and PCSK9 antibodies as options when a statin alone is not enough or cannot be tolerated.
- Test whether it is the drug. Some doctors use a short break and a rechallenge, which can show whether symptoms follow the statin.
Our ApoB blood test guide explains another marker that can help judge whether treatment is doing enough.
Frequently asked questions
Are statins safe to take long term?
For most people, yes. Statins have been studied in large trials for decades. The main risks, such as a small rise in diabetes risk and rare serious muscle damage, are generally outweighed by the reduction in heart attacks and strokes for people at increased risk.
Do statins cause muscle pain?
They can, but much less often than people think. In blinded trials, more than 90% of muscle symptoms reported by people on statins were not caused by the drug.
Do statins cause diabetes?
They slightly raise the risk. One large analysis found about one extra case of diabetes for every 255 people treated for four years.
Should I take statins if my risk is low?
Usually not, unless your LDL is very high or you have other risk enhancers. At low risk, the absolute benefit is small, and guidelines focus on lifestyle first.
Can I stop taking statins?
Not without talking to your doctor. Your LDL is likely to rise again after stopping, and the protection fades with it.
The bottom line
Statins lower LDL cholesterol and, with it, the risk of heart attack and stroke, by about a fifth for every 1 mmol/L drop in LDL. Most of the side effects people blame on them turn out, in blinded trials, to happen just as often on placebo, though some people do have persistent trouble with them and there are options when that happens. Whether you should take statins depends on your overall risk, which is a decision to make with your doctor using your numbers.
This article is for general information and is not medical advice. Do not start, stop or change any medicine without talking to your doctor.
Sources
- Cholesterol Treatment Trialists’ Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet, 2010
- Cholesterol Treatment Trialists’ Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet, 2022
- American College of Cardiology: SAMSON, Symptom Burden of Statins Compared With Placebo (2020)
- Sattar N et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet, 2010
- US Food and Drug Administration: Important safety label changes to cholesterol-lowering statin drugs (2012)
- University of Illinois Chicago Drug Information Group: Key updates from the 2026 dyslipidemia guideline
- National Lipid Association: Managing the statin-intolerant patient, low-dose and low-frequency regimens (2026)