High cholesterol: Should I take statins?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But if you have too much, it starts to build up in your arteries. The higher your cholesterol, the greater your risk for heart disease. Too much cholesterol in your blood can lead to a heart attack or a stroke.

There are two kinds of cholesterol.

• Low-density lipoproteins (LDL) are the "bad" cholesterol. LDL can clog your arteries.
• High-density lipoproteins (HDL) are the "good" cholesterol. HDL helps clear the bad cholesterol from your body so it doesn't clog your arteries.

Triglycerides are another type of fat in the blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

A simple blood test tells you how much cholesterol you have. The test results are given in numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To find out this risk, your doctor will also consider your age, your family history, your blood pressure, and if you smoke.

• LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
• HDL should be high. A good HDL goal is 40 or higher. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. A high HDL number can help offset a high LDL number.
• Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

High cholesterol is just one of several risk factors that make heart attacks or strokes more likely. If you have high cholesterol and another risk factor, heart attacks and strokes are even more likely. Some risk factors are things you may be able to control. Others are things you can't control.

Risk factors you may be able to control include:

• Diabetes.
• High cholesterol.
• High blood pressure.
• Smoking cigarettes.
• Being overweight.
• Not exercising.

Risk factors that you can'tcontrol include:

• Your age. Men age 45 or older and women age 55 or older have a higher risk.
• Having one or more close relatives who have or had early heart disease.

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

Therapeutic lifestyle changes and medicines called statins are the two main treatments for high cholesterol. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack or a stroke. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps lower your risk of heart problems.

The way high cholesterol is treated will depend on your cholesterol levels, your risk for a heart attack, and your personal preference about taking medicines.

Why are lifestyle changes so important?

Some people can lower their cholesterol just by making lifestyle changes such as eating less saturated fat, losing weight, exercising, and quitting smoking.. Others will need to take pills as well. But some lifestyle changes are important for everyone with high cholesterol. Even with statins, you will need healthy habits for the rest of your life to lower your risk of a heart attack.

If you decide to try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try lifestyle changes for 3 to 6 months. If your cholesterol doesn't come down enough in that time, you may decide to start taking statins.

If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take pills to keep your cholesterol down. And if you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, your doctor may want you to starting taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.

How can statins help lower cholesterol?

Statins and statin combinations are medicines that reduce the body's natural production of cholesterol. They make "bad" LDL cholesterol levels in the blood go down and help lower triglycerides. Statins can also raise "good" HDL cholesterol. Statins may be used alone, or they may be combined with other medicines.

Guidelines from the United States National Cholesterol Education Panel advise use of statins in people who are at moderate to high risk of coronary artery disease.¹

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

Studies show that statins and statin combinations can:

• Slow the spreadof heart disease.^{2, 3}
• Lower the risk of heart attack.
• Lower stroke risk.
• Reduce LDL by 18% to 55%.⁴ This means that if your LDL is 200, taking a statin could lower your LDL to between 164 and 90.
• Increase HDLby 5% to 15%.⁴ This means that if your HDL is 60, taking a statin could increase your HDL to between 63 and 69. The higher your HDL, the better. An HDL of 60 and higher protects against heart disease.

You'll need blood tests to check your liver each year while you are taking the pills. Statins may cause liver problems, and the blood tests check how well your liver is working.

Your doctor may recommend that you take statins or statin combinations if:

• You have high "bad" LDL cholesterol and low "good" HDLcholesterol.
• You have diabetes, high blood pressure, or heart disease.
• You are at high risk of having a heart attack, or you already have heart problems.
• You have tried being more active and changing your diet, but these changes did not lower your cholesterol enough.