Statins are among the most widely prescribed medications in Australia, and for good reason. These cholesterol-lowering medications have been used safely and effectively for more than 30 years to reduce the risk of heart attack and stroke. But despite decades of evidence, many Australians are still hesitant to take them, or stop taking them once they’ve been prescribed.
At Central Heart, our doctors understand that starting any medication is a big decision, and we’re here to help guide you and your family. In this article, we explain how statins work, what the latest research says about their safety and effectiveness, and tackle some of the most common myths. As always, we recommend that you speak to your GP or our team of cardiologists at our North Gosford or Toukley clinics for specific advice on your heart health.
Meet Jill, a healthy woman with an inherited genetic risk
Jill is a 52-year-old woman with no significant past medical history. She maintains a healthy lifestyle, including a balanced diet, regular exercise five days a week, and no history of smoking. She has never had any concerning symptoms for heart disease, including chest pain or breathlessness. Despite her overall good health, she has a notable family history of cardiovascular disease—her father experienced his first myocardial infarction at age 50, which required coronary artery bypass grafting (CABG).
Due to this family history, Jill presented to her general practitioner for a cardiovascular risk assessment. Her blood pressure was within the normal range, but routine blood tests revealed moderately elevated cholesterol levels (total cholesterol: 7.6 mmol/L; LDL: 4.8 mmol/L). To further assess her cardiovascular risk, a coronary artery calcium (CAC) score was performed, which showed a mildly elevated result of 20 Agatston units.
Why is this so?
As we age, it’s normal for everyone to develop some degree of plaque build-up in the arteries. However, in some individuals, this process begins earlier due to factors such as unhealthy lifestyle choices or inherited genetic risk.
In Jill’s case, despite her healthy lifestyle, her unfavourable cardiovascular genetics place her at higher risk for premature cardiovascular disease.
Her coronary artery calcium (CAC) score is 20 Agatston units, which reflects a low absolute burden of plaque. However, this score places her in the 90th percentile for women her age—meaning she has more coronary plaque than 90 per cent of her peers. This finding is consistent with a genetic predisposition contributing to early plaque development.
Initiating a statin to lower her LDL (low-density lipoprotein) cholesterol to a target of less than 1.4 mmol/L is recommended. This approach can help stabilise the existing plaque and significantly slow the progression of new plaque formation. The goal is to reduce her long-term risk of cardiovascular events and, ideally, delay or prevent them altogether—supporting a long and healthy life with good quality of life.
Why LDL-Lowering Is Important: Cumulative LDL-C—Years Versus Age (J Am Coll Cardiol. 2020;76(13):1517–1520.)
This graph demonstrates the speed at which we develop plaque and cardiovascular disease depending on our risk factors and lifelong cholesterol levels. The dotted line represents the point in life where cardiovascular disease develops. The green line represents those with lower LDL cholesterol for whom cardiovascular disease occurs much later in life, if at all. Treating cholesterol can shift the curve to the right.
What are statins, and how do they work?
Statins work by reducing your body’s production of LDL cholesterol, or what most people know as “bad” cholesterol. They also help stabilise plaque (a build-up of cholesterol and calcium) in the arteries and reduce inflammation in the blood vessels — both of which help prevent future cardiovascular events, including heart attack and stroke.
They’ve been a core part of Australian cardiac care since the 1990s and are recommended by all major domestic and international guidelines, including the Heart Foundation and the Royal Australian College of General Practitioners.
When do we recommend statins and why?
We aim to prescribe cholesterol-lowering therapy such as statins when somebody has either significant risk factors for premature cardiovascular events, or they have proven premature, unstable or a high burden of arterial plaque (sometimes likened to ‘rust in the pipes’). To help assess your risk, we can use the Australian Cardiovascular Disease Risk Calculator. This tool combines your age, cholesterol, blood pressure, and other health factors to estimate your five-year risk of a cardiovascular event, including heart attack or stroke. We can also use imaging tools such as CT coronary calcium scoring and CT coronary angiography (CTCA) to visualise if plaque has already formed in your arteries.
Risk factors that may put someone at a higher risk of heart attack or stroke include:
- People with very high cholesterol levels (often due to a genetic predisposition, and sometimes a genetic mutation such as familial hypercholesterolaemia).
- People with diabetes, high blood pressure, or a strong family history of early heart disease, even if their cholesterol is ‘normal’ or only modestly raised.
- People with chronic inflammatory conditions such as rheumatoid arthritis or lupus.
- Cancer survivors, as cancer and certain cancer treatments may increase cardiovascular risk.
- Anyone who’s already suffered a heart attack or stroke, or had a stent inserted.
Debunking common myths
People who reject or decide to cease statin therapy, often due to misinformation, has been a challenge to our health care system for some time. A recent US study found that 1 in 5 people at high risk of heart disease refuse statins, even when they’ve been recommended by their doctor. As a result, they take much longer to reach safe cholesterol levels, significantly increasing their risk of heart attack or stroke. The study also found that women were more likely to reject treatment than men.
Trials have suggested the need to lower LDL (bad) cholesterol after a heart attack, stroke or diagnosis of heart disease. We used to aim for an LDL of less than 1.8mmol/L, but in recent years has shifted to targeting less than 1.4mmol/L. However, only around 35 per cent of people reach the higher target goal of less than 1.8mmol/L for a variety of reasons, including poor adherence to cholesterol-lowering medications.
The Australian Heart Foundation believes the findings are a clear warning. With an estimated 6.5 million Australians living with high cholesterol, and 3.6 million of them women, it’s important to seek medical advice early if you have concerns.
Myth 1: You only need a statin if your cholesterol is high
It’s true that statins are often prescribed to lower cholesterol, but that’s not the only reason we recommend them. Sometimes, even if your cholesterol levels look fairly normal, there may still be strong reasons to start treatment.
For example, if you have a family history of early heart disease, such as a parent who died suddenly from a heart attack at a young age, your lifetime risk is much higher. In these cases, a statin can be an important tool.
Interestingly, statins do more than just lower a number on your blood test. They also help to stabilise and even shrink the fatty plaques that build up in your arteries. This makes them less likely to rupture and cause a heart attack. In other words, statins can actively change the course of heart disease, not just manage it.
Myth 2: Statins cause muscle pain
Statins are heart attack prevention drugs and plaque stabilisers. Side effects such as muscle pain are uncommon and, in most cases, related to the placebo rather than the active ingredient within the medication.
In well-conducted trials, less than five per cent of people report muscle aches on statins. Additionally, recent trials and amalgamated data support that muscle aches/pain occur with similar frequency in the placebo arm as the statin arm in randomised trials. This is related to the “nocebo” effect, a phenomenon where a negative expectation of a treatment or intervention leads to experiencing negative side effects or worsening of symptoms.
If you do experience any muscle pain, your cardiologist can adjust the dose, try a different statin, or pause briefly while re-assessing.
Myth 3: Statins lead to memory loss
There is no evidence linking statins to dementia or memory decline. Cardiovascular disease itself can be associated with vascular dementia and accelerated memory loss. In contrast, consensus from guidelines and research studies suggests statins are safe from a cognitive perspective, and by reducing vascular risk, they may indirectly reduce the risk of vascular cognitive impairment.
Myth 4: Statins cause diabetes
Statins can slightly increase blood sugar levels in some people, but the risk of developing diabetes is small, around 1 in 200 over five years. Research indicates that statin medications do not induce diabetes in someone who isn’t already nearing a diabetes diagnosis, and the benefits in preventing heart attacks and strokes far outweigh this.
Myth 5: I’m too old for statins to help
This is untrue. People over 75 can still benefit from statins, particularly if they’ve had previous heart events or are shown to be at high risk. Age alone isn’t a reason to stop or avoid treatment.
Myth 6: Statins are pushed by the pharmaceutical industry for profit
Statins are now cheap, generic medicines that have been off-patent for many years. Neither pharmaceutical companies nor doctors stand to gain financially by promoting them. The reason statins are so widely recommended is because they work: decades of high-quality research has shown that statins lower cholesterol and reduce the risk of heart attack, stroke, and premature death.
Get clear advice on your heart health at Central Heart
Seeking medical advice early can save your life. At Central Heart, we take a personalised approach that involves looking at your full medical history, family background, and how your heart is functioning. We’ll explain your options clearly, answer any questions you have and, most importantly, involve you in every step of the decision.
Whether you choose to take a statin or not, our care remains the same. Our role is to provide the evidence, context, and support you need, while recognising that everyone’s tolerance for risk is different. Not everyone’s risk can be perfectly predicted, but we can give you figures and guidance to help you make the decision that feels right for you.
It’s worth noting that whilst they are first line for their many proven benefits, statins aren’t our only cholesterol-lowering medications. Sometimes, these are prescribed in combination with statins, or independently to help us achieve our cholesterol targets to reduce our risk for future cardiovascular events. New injectable treatments are available for patients at very high risk (with previous heart attack or stroke) who haven’t been able to hit their targets with tablets.
If you’re unsure whether a statin is right for you or a family member, book an appointment with your GP or our cardiology team.