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When is a statin needed to lower my cholesterol?

Northshore Hospital, Long Island, N.Y.

Statins are wonderful medicines, because even though they can have side effects, you are safer taking the statin, which has been shown to reduce the risk of a heart attack or a stroke.  

Often, I hear patients express concerns: "But I hear so much on TV about all these side effects and risks and my liver and I have to have a blood test every year, and I don’t really like to pop a pill."

That’s a concern that is shared by many, and I’m not going to force you to take a pill. The truth is, you’ve been having problems because of your cholesterol probably for the last 10 or 15 years as the plaques have been building up in the arteries of your heart. This is not a problem that just developed today. It’s just that your blood level of cholesterol is abnormal for the first time or you have had a cardiovascular event.

So we now have to have this discussion. The fact that you’ve heard about side effects of the medicine means that you’re well informed. That’s good, so you understand how important it is to come back and have that blood test once you start the medication or the dose has been changed. One of the great things that we’ve learned from a lot of the large trials that have been done with statins over three, four, five years of follow-up is that the number of patients who actually have a problem is not all that different from placebo, in terms of liver abnormalities. And we’re not talking about liver failure, needing a liver transplant, dying from liver dysfunction, having to change your lifestyle because of liver dysfunction. What we’re talking about here is an abnormality in the blood test that when we change the dose of your statin, or stop it, goes away. At the same time, statins are drugs that reduce your risk of a heart attack or stroke substantially.