UK HealthCast: Understanding statin therapy

UK HealthCast is a podcast series featuring interviews with UK HealthCare experts on a variety of health-related topics.

Few medications have been studied as extensively as statins. For decades, they have been a cornerstone of cardiovascular care, helping millions of people lower their risk of heart attack, stroke and other serious complications related to cholesterol buildup in the arteries.

Despite their widespread use, questions and misconceptions about statins remain common. Patients often wonder whether they really need one, how long they will need to take it and whether the potential side effects outweigh the benefits.

According to Dr. Lucas Shelton, medical director of UK HealthCare Primary Care Frankfort, the answer depends on a person's cardiovascular risk profile and medical history. For the right patient, statins can be one of the most effective tools available for preventing cardiovascular disease. 

Dr. Shelton recently joined UK HealthCast to discuss statin therapy. You can listen to Dr. Shelton’s conversation below. For key takeaways from that conversation, please continue reading.

What are statins?

Statins are medications designed to lower LDL cholesterol, often referred to as "bad" cholesterol. They work primarily in the liver, where cholesterol is produced and processed.

By blocking part of the body's cholesterol-production pathway, statins reduce levels of LDL cholesterol that can contribute to plaque buildup inside arteries. Over time, that plaque can narrow blood vessels and increase the risk of heart attack, stroke and other cardiovascular events. 

While cholesterol is often discussed as a single number, it is made up of several different components. Statins specifically target the type of cholesterol most strongly associated with cardiovascular disease. As a result, their benefits extend far beyond simply improving a laboratory result. They are intended to reduce the risk of serious, life-altering medical events.

Two different groups of patients

When deciding whether someone should take a statin, providers generally place patients into one of two categories: primary prevention or secondary prevention. 

Secondary prevention

Secondary prevention applies to people who have already experienced a cardiovascular event or who have established arterial disease.

This group may include patients who have had:

• A heart attack
• An ischemic stroke or "mini-stroke"
• Coronary artery disease
• Peripheral arterial disease affecting the arms or legs
• Plaque buildup in arteries supplying the abdomen, neck or brain

For these patients, the evidence supporting statin therapy is overwhelming.

Statins have been proven to reduce the risk of future cardiovascular events, decrease the likelihood of additional heart attacks and strokes, and lower the risk of death related to cardiovascular disease. Dr. Shelton emphasizes that these benefits exist regardless of what a patient's cholesterol numbers currently look like. 

Primary prevention

Primary prevention refers to patients who have never experienced a cardiovascular event and do not have known arterial disease. 

These are often the patients seen during routine primary care visits. A provider reviews blood work, including a lipid panel, and evaluates overall cardiovascular risk.

In this group, the decision to start a statin is more individualized. Factors that may influence risk include:

• Age
• Blood pressure
• Diabetes
• Smoking history
• Cholesterol levels
• Other medical conditions that affect cardiovascular health

For patients whose risk is sufficiently high, statin therapy can help prevent a first heart attack or stroke before it happens, which can have a significant long-term impact on health and quality of life. 

Why prevention matters

Heart disease remains one of the leading causes of death and disability. Often, cardiovascular disease develops silently over many years.

Plaque can slowly accumulate in artery walls without causing symptoms until a serious event occurs. The first sign of disease may be a heart attack, stroke or blocked artery.

This is why preventive care is so important. Statins offer providers a way to reduce risk before a major event happens. For patients with sufficient cardiovascular risk, preventing a first heart attack can be just as important as preventing a second one.

Understanding potential side effects

Like any medication, statins can cause side effects. However, many concerns surrounding the drugs are often misunderstood.

The most reported side effect involves muscle symptoms, including aches, soreness or cramping. In clinical practice, Dr. Shelton said that up to about 10% of patients may report muscle-related symptoms. 
Importantly, he emphasizes that many patients tolerate statins without significant problems, and providers have options when side effects occur. Switching to a different statin, adjusting the dose or considering alternative therapies may help patients continue receiving cardiovascular benefits while minimizing discomfort. 

There is also a small increase in diabetes risk associated with statin use. Dr. Shelton notes that the reported rate is approximately 0.2% per year. However, he stresses that this risk is generally far outweighed by the cardiovascular benefits for patients who are appropriate candidates for treatment. 
Serious liver toxicity is possible but extremely rare. In fact, the risk is so low that routine ongoing liver-enzyme monitoring for patients on statins is no longer broadly recommended. 

Addressing common myths

Social media and online forums have contributed to a growing number of misconceptions about statins.
Among the most common concerns Dr. Shelton encounters are fears that statins cause dementia, cognitive decline, kidney disease or cancer. Scientific evidence does not support those claims.

Dr. Shelton says there is no evidence that statins cause any of these conditions. Still, these misconceptions can sometimes prevent patients from considering a medication that could meaningfully reduce their risk of cardiovascular disease. 

Dr. Shelton encourages open conversations between patients and their health care providers. Rather than relying solely on information found online, patients should discuss concerns directly with clinicians who can explain the available evidence and how it applies to their individual circumstances. 
New guidelines and a new risk calculator

A significant development in cholesterol management occurred earlier this year with the release of updated lipid management guidelines from the American College of Cardiology, American Heart Association and other cardiovascular societies. One of the most notable changes is the adoption of the PREVENT ASCVD Risk Calculator, a newer tool designed to help clinicians more accurately estimate cardiovascular risk.

According to Dr. Shelton, the calculator is based on data from millions of patients and reflects a more modern population than previous risk assessment tools. The update allows providers to better identify which patients may benefit most from preventive therapies, including statins. 

For primary care providers, these updated guidelines offer a more precise approach to determining who should start treatment and when.

How long do patients stay on statins?

The answer varies depending on why the medication was prescribed.

For patients in the secondary prevention category, statins often provide ongoing benefit because cardiovascular disease is already established. In many cases, treatment is continued indefinitely to reduce the risk of future events. 

For patients taking statins for primary prevention, the conversation can become more individualized as they reach older age. Around ages 75-80, providers may discuss the potential benefits and risks of continuing treatment based on overall health, life expectancy and personal preferences. 

Starting the conversation

If you've been told your cholesterol is elevated or that you may benefit from a statin, the best next step is a conversation with your primary care provider.

A clinician can review your cholesterol levels, blood pressure, diabetes status, smoking history and other factors that contribute to cardiovascular risk. Using updated risk assessment tools and clinical judgment, they can determine whether statin therapy makes sense for your situation.

Statins are not necessary for every patient. But for many people, they remain one of the most effective and well-studied strategies for reducing the risk of heart attack, stroke and other cardiovascular complications.