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decision pointShould I take statins for high cholesterol?

Lowering your high cholesterol can help you prevent a heart attack or stroke. Consider the following when making your decision:

  • High cholesterol is only one of several risk factors for heart disease. To reduce your risk of coronary artery disease (CAD) and heart attack, you need to reduce all of your risk factors, not just high cholesterol.
  • Guidelines from the U.S. National Cholesterol Education Panel recommend more intensive treatment with statins for people who are at moderate to very high risk of CAD.1 It is important, though, that you discuss with your doctor whether statins are appropriate for you, based on your condition and medical history.
  • The choice is less clear for people who have moderately high cholesterol and few risk factors for CAD and heart attack. This group may find this decision point most helpful.
  • Therapeutic lifestyle changes are as important as medicine in reducing your risk for CAD and heart attack. For some people, quitting smoking, reducing blood pressure, losing weight, or getting more exercise can have the same or greater impact on reducing the risk of heart disease than taking medicine.

What is cholesterol, and why is high cholesterol dangerous?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But too much cholesterol in your blood increases your chances of heart attack and stroke.

What raises my chances of getting CAD and having a heart attack or stroke?

Your chances are higher if you:

  • Are a man age 45 or older or a woman age 55 or older.
  • Have one or more close relatives who have or had early coronary artery disease.
  • Have smoked any cigarettes within the past 30 days.
  • Have high blood pressure (140/90 mm Hg or above) or are taking medicine for high blood pressure.
  • Have a low HDL cholesterol level (below 40 mg/dL or 0.91 mmol/L).
  • Have diabetes.

What are other risk factors?

Other factors that put you at risk for CAD and heart attack include high homocysteine levels, obesity and lack of regular exercise, menopause and the drop in estrogen that follows it, and metabolic syndrome.

An important part of your decision about whether to take statins is determining your risk for coronary artery disease and heart attack.

Use the Interactive Tool: Are You at Risk for a Heart Attack?

Along with medical guidelines for taking medicines, your decision about whether to take statins to lower your cholesterol level includes your personal feelings.

Deciding about using statin medicines
Reasons to use statin medicines Reasons not to use statin medicines
  • Your LDL cholesterol is over 190 mg/dL.
  • Your total cholesterol is over 240 mg/dL.
  • You have two or more risk factors for CAD or have a condition as serious as CAD.
  • Medicine is easy and convenient to use.
  • You have tried being more active and making changes to your diet, but it did not lower your cholesterol to the target you set.
  • Statins are proved to lower the risk of heart attack, stroke, and death in people with high cholesterol who have a high risk of heart attack and stroke.2, 3
  • Statins reduce LDL by 18% to 55%.4
  • Statins increase HDL by 5% to 15%.4
  • Statins reduce triglycerides by 7% to 30%.4

Are there other reasons why you might want to use medicines to lower cholesterol?

  • Your LDL cholesterol is below 100 mg/dL.
  • You may have to take medicine for the rest of your life.
  • You may need periodic blood tests to check liver function.
  • You may be able to reduce cholesterol levels through diet and exercise.
  • Medicines may be expensive for you if insurance does not pay for them.
  • You may have side effects from taking medicine.

Are there other reasons why you might not want to use medicines to lower cholesterol?

Medicine choices

Statins and statin combinations are the most effective and widely prescribed cholesterol-lowering medicine. They include:

  • Atorvastatin (Lipitor).
  • Atorvastatin with amlodipine (Caduet).
  • Ezetimibe with simvastatin (Vytorin).
  • Fluvastatin (Lescol).
  • Lovastatin (Mevacor).
  • Pravastatin (Pravachol).
  • Rosuvastatin (Crestor).
  • Simvastatin (Zocor).

Other medicines also lower cholesterol, and some may be used to lower triglycerides or raise HDL. They include:

  • Bile acid sequestrants.
  • Cholesterol absorption inhibitors.
  • Fibric acid derivatives.
  • Nicotinic acid.

These medicines are sometimes used in combination with a statin.

These personal stories may be helpful in making your decision.

Use this worksheet to help you make your decision. After completing it, you will have a better idea of how you feel about taking medicine to lower cholesterol levels. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My doctor has told me that my risk for CAD is high. Yes No Unsure
My LDL cholesterol level is above 190 milligrams per deciliter (mg/dL). Yes No Unsure
The NCEP guidelines recommend that I take medicine. Yes No Unsure
I have the finances and/or insurance to pay for medicine. Yes No Unsure
I worry about my cholesterol levels. Yes No Unsure
I worry about getting CAD or having a heart attack. Yes No Unsure
I believe that medicine can help me. Yes No Unsure
I am comfortable with taking medicines long-term or for the rest of my life. Yes No Unsure
I feel I can cope with the side effects of cholesterol-lowering medicine. Yes No Unsure
I don't mind having regular blood tests for liver function. Yes No Unsure
Medicine that I'm currently taking may interfere with medicine to lower cholesterol. Yes No NA*
Diet and exercise have not helped me lower my cholesterol to my goal. Yes No NA
I have difficulty staying on a diet. Yes No NA
I have difficulty staying with an exercise program. Yes No NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicines.

Check the box below that represents your overall impression about your decision.

Leaning toward taking medicine for high cholesterol

 

Leaning toward NOT taking medicine for high cholesterol

         

Citations

  1. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]

  2. Pignone M (2007). Primary prevention: Dyslipidaemia, search date March 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

  3. Gami A (2007). Secondary prevention of ischaemic cardiac events, search date July 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

  4. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.

Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Last Updated July 11, 2008

WebMD Medical Reference from Healthwise

Last Updated: July 11, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Is This Normal? Get the Facts Fast!

Is Your Cholesterol Level Heart Healthy?
What is your LDL (low-density lipoprotein) level?

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or
Answer:
Desirable
0-199
Borderline
200-239
High
240+

Your level is currently

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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