Do I need statins for high cholesterol?

Being told you might need a statin often brings a mix of reactions.

For many people, it feels like a big step, especially if you feel completely well. You might find yourself wondering why medication is needed at all, or whether this is something that could be managed without tablets.

These are very reasonable questions. In most cases, this is not a decision that needs to be rushed. It is something worth understanding properly, so you feel confident in whatever choice you make.

When are statins actually recommended?

The decision to start a statin is not based on cholesterol alone.

Instead, it is based on your overall chance of developing heart disease over time. In simple terms, this means your likelihood of having a heart attack or stroke in the years ahead.

This is influenced by several factors, including your age, blood pressure, smoking status, medical history such as diabetes, and your cholesterol levels.

In the UK, tools such as QRISK are commonly used to estimate your 10 year cardiovascular risk. This helps decide whether treatment is likely to make a meaningful difference for you.

So rather than focusing only on whether your cholesterol is high, the more useful question becomes whether lowering it is likely to change your future risk in a meaningful way.

How do statins actually help?

Statins work by reducing the amount of cholesterol your liver produces, particularly LDL cholesterol, which is the type most closely linked to plaque build up in the arteries.

They also help to stabilise existing plaques within the artery walls. This makes them less likely to rupture and form a clot, which is the event that can lead to a heart attack or stroke.

Because of this, the benefit of statins is not just about lowering cholesterol. It is about reducing your chances of future heart attacks or strokes.

Can I try lifestyle changes first?

In many cases, yes. Lifestyle changes are always an essential part of treatment.

Improving diet, increasing physical activity, and maintaining a healthy weight can all help improve heart health and lower your overall risk.

For people at lower risk, these changes may be enough on their own.

However, if your overall risk is higher, lifestyle changes alone may not reduce your chances enough.

In these situations, statins are often recommended alongside lifestyle changes to provide a greater and more reliable reduction in your long term chances of heart disease.

Are statins safe to take?

Statins are widely used and have been studied extensively over many years.

Most people take them without significant problems.

Some people may experience side effects such as mild muscle aches, headaches, digestive symptoms, or changes in sleep. These are usually mild and often improve over time or with adjustments to treatment.

Large clinical studies have shown that serious side effects, such as significant muscle injury or liver problems, are uncommon.

If side effects do occur, there are usually ways to manage them. This might include adjusting the dose, trying a different statin, or considering alternative treatments.

If I start, will I need to take them long term?

This is one of the most common concerns.

Statins do not remove the underlying tendency for cholesterol to be elevated. They help keep it under control. If treatment is stopped, cholesterol levels usually rise again over time.

For many people, statins are recommended as a long term treatment because they provide ongoing protection against cardiovascular events.

That said, treatment should always be reviewed periodically to make sure it still reflects your level of risk and your preferences.

What happens if I stop taking a statin?

If a statin is stopped without an alternative plan, cholesterol levels are likely to increase again, and your long term chances of heart disease may rise.

The protective effect of statins builds over time, so stopping and restarting treatment can reduce the consistency of that protection.

If you are considering stopping, it is important to discuss this with your doctor so you can make an informed decision.

Are statins only for older people?

Not necessarily.

Although cardiovascular risk increases with age, statins may be recommended earlier if your overall risk is elevated for other reasons.

This may include very high cholesterol levels, a strong family history of heart disease, or conditions such as diabetes.

In some cases, inherited conditions such as familial hypercholesterolaemia can lead to significantly elevated cholesterol from a young age and require earlier treatment.

Do women need a different approach?

The overall approach to treatment is similar, but there are some important considerations.

Cardiovascular risk in women is sometimes underestimated, particularly before menopause. After menopause, risk increases as hormonal changes affect cholesterol levels and blood vessel health.

Other factors, including pregnancy related complications or conditions such as polycystic ovary syndrome, may also influence long term cardiovascular risk and should be taken into account when making treatment decisions.

When should I speak to a doctor?

It is worth having a conversation if you have been advised to start a statin and feel unsure, if you are experiencing possible side effects, or if you would like a clearer understanding of your overall risk.

At its core, the decision to start a statin is not about treating a number. It is about reducing your risk in a meaningful and sustainable way.

Once you understand your risk, the decision becomes clearer. It becomes less about uncertainty and more about choosing what best protects your long term health.

About the author

Dr Peter Kabunga is a Consultant Cardiologist and Electrophysiologist with extensive experience in heart health, particularly in diagnosing and managing conditions such as high cholesterol and its impact on cardiovascular risk. He works within the NHS at Darent Valley Hospital and King’s College Hospital and is accredited in cardiac electrophysiology by the British Heart Rhythm Society.