Cardiology
Statins have changed the way we prevent and treat heart disease and stroke.
Knowing what these drugs do, when to use them, and how they can benefit your health can guide you in making smart choices about your heart care.
What are statins and how do they work?
Statins are a class of medications that work by blocking an enzyme called HMG-CoA reductase, which plays a crucial role in cholesterol production in the liver, says Dr Jonathan Hooijer, a physician at Mediclinic Morningside. “About 80% of the cholesterol in your body is produced by your liver, while 20% comes from dietary sources. By inhibiting this key enzyme, statins effectively reduce the amount of cholesterol your body manufactures.”
Cholesterol is a substance your body needs to build cells and make hormones. When your liver makes less cholesterol, it starts pulling more from your bloodstream to get what it needs. This helps lower the amount of cholesterol in your blood, especially low-density lipoprotein (LDL) cholesterol —the kind often called “bad” cholesterol because it can clog your arteries and lead to heart problems.
But Statins do more than just lower cholesterol – they also help protect your heart in other ways. “They can help stabilise any existing plaque (fatty build-up) in your arteries, so they’re less likely to rupture and cause heart attacks or strokes,” says Dr Hooijer. “Statins also have anti-inflammatory properties and may improve the function of blood vessel walls, contributing to overall cardiovascular health.”
When do I need statins?
Your doctor doesn’t just look at your cholesterol levels when deciding to prescribe statins. They also consider your overall risk of heart disease. Statins may be recommended if:
- You already have heart or blood vessel problems, like a past heart attack, stroke, coronary artery disease, or peripheral artery disease. In these cases, statins help prevent future issues.
- Your LDL cholesterol is very high (usually 3.0 mmol/l or higher), even if you don’t have other risk factors. This could be due to a genetic condition, and lifestyle changes alone might not be enough.
- You have diabetes, which raises your risk of heart disease.
- You have a high overall risk of heart disease, based on factors like your age, sex, blood pressure, smoking, family history, and cholesterol levels.
Potential side-effects
“Statins are generally well tolerated and very few people experience side-effects,” says Dr Hooijer. The most common is muscle pain or weakness. In rare cases, statins can cause more serious muscle problems or changes in liver function. Some people also report memory or cognitive issues, but research shows these are uncommon and usually reversible “For most people, the cardiovascular benefits of statins far outweigh the potential risks, especially if they’re at high risk of heart disease or stroke,” he adds.
Your lifestyle still matters
Statins are not a substitute for healthy lifestyle choices. “They work best when combined with a heart-healthy diet, regular exercise, not smoking, and managing your weight,” Dr Hooijer says.