Afraid to take a statin?
Many people are. You may have heard about aches, memory loss, or diabetes from a friend, a relative, or the internet. Here is what the large blinded studies show, which worries are real, and how we can start in a way that feels safe to you.
From Dr. Kenneth Civello, MD, MPH, cardiologist and electrophysiologist
Why I recommend it
LDL cholesterol builds plaque in your arteries. Plaque causes most heart attacks and strokes. A statin lowers LDL more reliably than anything else we have.
Statins have been used since the 1980s and tested in more than 170,000 people in long blinded trials. Every drop of about 39 points in LDL lowers the chance of a heart attack or stroke by about a fifth. The bigger the drop, the bigger the benefit.
Plaque grows without symptoms. Feeling fine does not mean your arteries are fine. That is why we treat the number before something happens.
My job is to give you the facts and help you weigh them. If you decide not to take a statin, we still have other ways to lower your risk. I would rather you tell me your worry than fill the prescription and never take it.
Muscle aches
This is the worry I hear most. Real statin aches do happen, but far less often than most people think.
Researchers pooled 19 large blinded trials of more than 120,000 people. Half took a statin and half took a sugar pill, called a placebo. Nobody knew which one they had. Over about 4 years, muscle aches were just as common in both groups.
On a statin
On a placebo
The statin did cause a small number of extra aches. In the first year, about 1 extra person in 100 had aches from the statin itself. After the first year, there was no difference. More than 9 in 10 aches that people on statins reported were not caused by the statin.
Why expecting aches can cause them
When you expect a pill to hurt you, your body can feel real pain. This is called the nocebo effect. It is the opposite of the placebo effect, and it is not imagined.
In one study, 60 people who had stopped statins because of side effects took a statin for some months, a placebo for other months, and nothing for the rest. They did not know which. About 90 percent of the symptoms they felt on the statin came on the placebo too.
In a larger study of 200 people who had stopped or nearly stopped statins because of aches, aches were no worse on the statin than on the placebo. Two thirds of those who finished went back on a statin.
What makes real statin aches more likely
Higher doses, older age, low thyroid, kidney or liver disease, heavy alcohol use, and some other medicines raise the chance. Real statin aches are usually in both thighs, both shoulders, or the large muscles, and they start in the first weeks or months. They go away within a few weeks of stopping.
Other worries
Here is what the evidence says about the other side effects patients ask me about.
Memory and dementia
Large trials that tested memory found no harm. Long studies found people on statins are not more likely to get dementia. More on statins and memory.
Diabetes
Statins raise blood sugar a little. The average A1c rose by less than a tenth of a point. Most new cases were in people who were already close to diabetes. The heart benefit in the trials already counts this risk, and it is much larger.
Liver
Serious liver injury is rare. Since 2012, the FDA no longer asks for routine liver tests while you take a statin. We check once before you start.
Severe muscle damage
A breakdown of muscle called rhabdomyolysis is very rare. It is more likely with high doses combined with certain other medicines. We check your medicines before you start.
Cancer
In trials of more than 170,000 people, statins did not raise the risk of cancer, even at very low LDL levels.
"It is just a pill to make the numbers look good"
Statins lowered heart attacks, strokes, and deaths from heart disease in the trials. The benefit is in real events, not only in lab numbers.
A gentle start
If you are worried, we do not have to start with a full dose. Here is how I often begin with nervous patients.
Check the basics first
We check your thyroid, kidneys, and liver, and look at your other medicines. A low thyroid can cause aches on its own and raise the chance of statin aches.
Rate your aches before you start
Use the ache log below for one week before your first pill. Many people already have aches they had not noticed. Then you can compare honestly.
Start low
A low dose, sometimes every other day or a few days a week. Even a low dose lowers LDL. Rosuvastatin and atorvastatin last long enough in the body to work this way.
Pick a calm start date
Avoid starting the week you begin a new workout or travel. New aches from a new routine are easy to blame on the pill.
Step up if you feel well
After a few weeks, we move to every day, then raise the dose if your LDL needs it. We recheck your LDL about 4 to 12 weeks after each change.
If aches start
Call us before you stop. Mild aches can often be handled. We may pause the statin for 2 to 4 weeks. If the aches go away and come back when you restart, the statin is the likely cause. Then we try a lower dose, a different statin, or fewer days a week. Most people who had aches on one statin can take another.
Ache log
Rate your muscle aches from 0 to 10 for the week before you start, then once a week after. Nothing you enter leaves this device.
Print this page or write the numbers down, and bring them to your visit.
When to call
If you have severe muscle pain or weakness with dark urine the color of tea or cola. This can be a sign of muscle breakdown.
Call us at (225) 767-3900 if your skin or eyes turn yellow, if aches keep you from your normal day, or if new aches last more than a week or two. Do not stop your statin on your own. Call us first so we can make a plan.
If you still cannot take a statin
Very few people truly cannot take any statin. If you are one of them, or you choose not to, we still have good options. I don't want to take a statin covers each one.
Ezetimibe (Zetia)
A daily pill that blocks cholesterol from food. Cheap, generic, and rarely causes side effects.
Bempedoic acid (Nexletol)
A daily pill that works in the liver but not in muscle, so it rarely causes aches. It lowered heart attacks in people who could not take statins.
A shot
PCSK9 inhibitors (Repatha, Praluent) every two weeks or monthly, or inclisiran (Leqvio) twice a year after the first doses. They lower LDL by about half or more.
A coronary calcium score can also help us decide how hard to push. If you have no calcium and few other risks, waiting may be reasonable. How to lower your LDL cholesterol covers each medicine and your goal.
For your visit
- What is my chance of a heart attack or stroke over the next 10 years, with and without a statin?
- What is my LDL goal?
- Would a calcium score change your advice for me?
- Can I start with a low dose or every other day?
- Do any of my medicines or supplements interact with a statin?
- What should I do if I get aches?
Common questions
Will a statin keep me from exercising?
No. Exercise is safe and good for you on a statin. If you start a hard new workout, sore muscles from the workout are expected. Tell us if the soreness is far worse than usual or does not go away.
Should I take CoQ10 with my statin?
CoQ10 has not been shown to ease statin aches in good studies. It is safe to try if you want to.
Is red yeast rice a safer choice?
No. It works because it contains a natural statin. The dose varies from bottle to bottle, and some contain a toxin. A real statin at a known dose is safer.
Can I eat grapefruit?
Large amounts of grapefruit juice raise the level of simvastatin, lovastatin, and atorvastatin in your blood. Rosuvastatin and pravastatin are not affected. Ask us which one you take.
I had aches on a statin years ago. Should I try again?
Often, yes. Many people who had aches on one statin do well on another, at a lower dose, or a few days a week. We can start slowly and use the ache log to see what is really happening.
Will I have to take it forever?
Usually, yes. LDL goes back up within weeks of stopping, and the protection fades with it. Statins are meant to be taken long term, like a seat belt you wear every day.
This page is general education for my patients. It does not replace advice from your own doctor.
Based on: 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026. Newman CB, et al. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019. Cholesterol Treatment Trialists' Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta analysis of large scale, randomised, double blind trials. Lancet. 2022. Cholesterol Treatment Trialists' Collaboration. Effects of statin therapy on diagnoses of new onset diabetes and worsening glycaemia in large scale randomised blinded statin trials. Lancet Diabetes Endocrinol. 2024. Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010. Wood FA, et al. N of 1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects. N Engl J Med. 2020. Herrett E, et al. Statin treatment and muscle symptoms: series of randomised, placebo controlled n of 1 trials. BMJ. 2021. Nissen SE, et al. Bempedoic Acid and Cardiovascular Outcomes in Statin Intolerant Patients. N Engl J Med. 2023. US Food and Drug Administration. Important safety label changes to cholesterol lowering statin drugs. 2012.