Statins are the most prescribed drugs for lowering cholesterol. They block the liver enzyme HMG-CoA reductase — the key enzyme in cholesterol synthesis — which makes the liver take up "bad" LDL from the blood more actively.
By lowering LDL, statins slow the growth of atherosclerotic plaques and reliably reduce the risk of heart attack and stroke.
Who statins are indicated for
The ACC/AHA guidelines single out four groups for whom statins are discussed: those with LDL ≥190 mg/dL; those with diabetes aged 40–75; those with established cardiovascular disease; and people aged 40–75 with a 10-year ASCVD risk ≥7.5%. The 7.5% threshold is the point from which the expected benefit usually outweighs the risks.
The decision is always individual: additional risk factors, coronary calcium and patient preferences are taken into account.
Not just cholesterol
Besides lowering LDL, statins have pleiotropic effects: anti-inflammatory, antioxidant, and plaque stabilization. Partly for this reason their benefit is also linked to a reduction in hs-CRP, not only lipids.
Every 1 mmol/L reduction in LDL cuts the risk of major vascular events by about 20%.
Side effects and myths
Most people tolerate statins well. Muscle pain is possible (severe myopathy and rhabdomyolysis are rare), along with a temporary rise in liver enzymes and a small increase in the risk of type 2 diabetes in predisposed people. Real liver damage is rare.
Grapefruit juice and a number of medications raise the concentration of some statins. Stopping abruptly is inadvisable — the risk of events returns.
Reference ranges
Intensity of statin therapy by the expected LDL reduction (ACC/AHA):
| High intensity | LDL reduction ≥50% |
| Moderate intensity | LDL reduction 30–49% |
| Low intensity | LDL reduction under 30% |
| Prescription threshold | ASCVD risk ≥7.5% |
Calculate using this marker
Calculators where Statins is used directly:
Frequently asked questions
Will I have to take statins for life?
As a rule, yes: statins control rather than "cure" cholesterol levels, and after stopping, LDL returns to its previous level and the risk of events rises. Discontinuation or a switch is decided with a doctor, not on your own.
Are statins dangerous for the liver?
Serious liver damage is very rare. More often there is an asymptomatic and reversible rise in liver enzymes. Frequent routine ALT monitoring is not needed for most people; the focus is on symptoms and the baseline test.