A Closer Look at Cholesterol Medication Myths

In the decades since the Food and Drug Administration approved the first statin in 1987, these cholesterol-lowering medications have been thoroughly studied and proven to reduce cardiovascular risk. Yet misconceptions persist. Let's take a look at some of the myths — and dig in to why they're not true.

Myth 1: Everyone should take statins.

Dr. Pradeep Natarajan

Dr. Pradeep Natarajan

Statins are typically for people who have heart disease or face a higher risk of it, said Pradeep Natarajan, M.D., director of preventive cardiology at Massachusetts General Hospital. Otherwise, following a healthy lifestyle is your best bet.

That means focusing on vegetables, fruits, whole grains, poultry, fish, legumes (peas and beans), low-fat dairy products, nontropical vegetable oils and nuts. It also means limiting red meat, saturated and trans fats, sodium and added sugars, and exercising regularly. (Adults should aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity a week.)

Although statins can help lower heart disease and stroke risk for people with diabetes, cholesterol that needs to be controlled and other risk factors, “the vast majority” of people don’t need to be on statins, Natarajan said.

Myth 2: Statins commonly cause muscle problems.

Statins are usually well tolerated and safe, but, as with other medications, there may be side effects. Statin-associated muscle symptoms, also called SAMS, are one known side effect of statins, but it’s rare. Natarajan said a tiny percentage of reported muscle issues are actually related to statins, based on his review of various studies. Natarajan advises working with your doctor to find the cause of muscle pain before changing your treatment regimen.

Myth 3: Statins will hurt your ability to exercise.

Sometimes younger, active people taking statins complain about fatigue, but Natarajan is reluctant to blame the statins. People fitting this description often are placed on statins because they have either newly accumulated cardiovascular disease risk factors or have developed cardiovascular disease, he said. “In these scenarios, deconditioning and exercise intolerance can be from many different reasons,” he said.

Myth 4: Statins commonly cause muscle damage and hurt your heart.

The risk is extremely rare. Muscle breakdown can occur for many reasons, including medicines interacting with statins. Other underlying muscle problems may be a culprit as well. Natarajan counsels patients who are new to statins to get an evaluation if they’re having muscle symptoms to determine if there’s evidence of muscle breakdown. “But it turns out that this condition is quite rare, probably on the order of one in several thousands of statin prescriptions,” he said.

Myth 5: Older adults don't benefit from statins.

Studies of all age groups have shown statins can lower cholesterol. But as people age, multiple health conditions and physical or cognitive decline may limit what statin therapy can do for them. For someone over 75, the risks may outweigh the potential benefits. Use of a statin or not is highly individualized. A shared decision-making process between health care providers and their patients is needed to know whether a statin is beneficial.

Myth 6: Taking statins commonly leads to diabetes.

Studies show a small link between taking statins and a risk of Type 2 diabetes. However, that risk is largely confined to those who already have multiple risk factors for diabetes. The benefits of statins in reducing cardiovascular events far outweigh the risk of developing diabetes.

“That seems to be replicated in other kinds of studies, such as genetic studies, implying that there probably is some real relationship between lowering LDL cholesterol and risk of diabetes,” Natarajan said.

Myth 7: You should avoid statins if you have diabetes.

The opposite is true. Diabetes is a strong risk factor for heart attack and stroke, and studies show statins reduce that risk, Natarajan said.

Myth 8: Statins frequently cause memory loss, cognitive dysfunction or dementia.

man inspecting ground with magnifying glass“In clinical trials, when patients don’t know whether they’re on statins or a placebo, there have been no worrisome signals for cognitive decline or dementia,” Natarajan said. Based on these trials, there is no evidence that statins cause these cognitive issues.

It’s unclear whether statins are to blame for cognitive decline. A recent study of PCSK9 — a potent, non-statin, cholesterol-lowering medicine — involved thousands of patients and included cognitive assessments. Patients who took a placebo and those who took PCSK9 had the same cognitive scores. “So, it’s not unreasonable to transfer that over to statins for which this has been studied even less within clinical trials,” Natarajan said. “I don’t interpret statins as having a significant influence on dementia or cognitive decline.”

Statins can deplete Coenzyme Q10, a nutrient that occurs naturally in the body. Some believe replacing it via supplements could lessen muscle symptoms or prevent SAMS (statin-associated muscle symptoms). But there’s no clear clinical trial data to support that hypothesis, Natarajan said, and most CoQ10 supplements are not FDA regulated. “I generally have patients save money and not take coenzyme Q10,” he said.

Myth 10: Cholesterol-lowering drugs will affect your sex life.

It’s unlikely, Natarajan said. Those prescribed a statin may have a variety of symptoms associated with cardiovascular disease, including decreased sexual desire. “But so far, statins themselves have not been attributed with decreased libido,” he said.

Myth 11: You can get cataracts from taking statins.

Only one clinical trial suggested association with cataract formation, but those findings haven’t been replicated. That suggests statins don’t cause cataracts, but future studies are needed.

Myth 12: You need regular blood tests to check your liver and kidney function.

You should have a baseline blood test to ensure the liver and kidney are normal before starting a statin. Even if problems are found, statins may be recommended — with additional tests. “If there are lab abnormalities at baseline and statins are prescribed, then it’s worth checking liver function tests at least once more to verify the stability of those abnormalities,” Natarajan said.

If the baseline test reveals no problems, and no symptoms crop up after taking a statin, just typical cholesterol checks are needed.

Myth 13: Natural substances are safer or more effective than statins.

Red rice yeast extract contains a weak statin medicine that typically doesn’t meaningfully reduce cholesterol or cardiovascular risk, and it hasn’t been tested for safety.

Red rice yeast preparations, which aren’t regulated by the FDA, are usually over-the-counter supplements. “The primary concern is not so much benefit or lack of benefit, but it’s the concern about exposing patients to the risk of non-regulated preparations,” Natarajan said.

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