Do You Need Medication for High Cholesterol? Beware of Statin Side Effects

Here are a few scenarios to consider when deciding whether to take statins for high cholesterol.

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A friend recently told me that his physical examination revealed elevated cholesterol levels. His doctor explained that excessively high cholesterol increases the risk of heart disease and recommended cholesterol-lowering medication. However, my friend is neither overweight nor has any preexisting cardiovascular diseases. In this scenario, should he consider taking the medication? What are the potential side effects of cholesterol-lowering statin medications? This article will delve into these topics in detail.

When to Take Cholesterol Medication

Cholesterol, a waxy substance in the bloodstream, plays a crucial role in transporting fats to various body parts and returning excess fats to the liver for storage. It is also an essential nutrient for cell and hormone production.

This may seem paradoxical, as cholesterol is vital for the body, yet high cholesterol levels can increase the risk of heart disease and stroke.

Personally, I do not recommend taking cholesterol-lowering medication but rather advocate using nonpharmacological methods to lower cholesterol. So when is it appropriate to consider cholesterol-lowering medication?

Research indicates that cholesterol-lowering medication can reduce the risk of stroke and heart attack in patients with atherosclerotic heart disease. When cholesterol, fats, and other substances accumulate in the arteries, they form plaques. Cholesterol can build up in the middle layer of the blood vessel wall (intima-media), triggering inflammation. Over time, these inflammatory fragments may grow, eventually breaking off into the bloodstream and potentially causing heart attacks and strokes. In such cases, patients taking cholesterol-lowering medication may reduce the growth rate of plaques and mitigate the inflammatory response caused by plaque.

Therefore, it is not necessary to start cholesterol-lowering medication solely based on high blood lipid levels. However, individuals diagnosed with atherosclerosis-induced heart disease, or those at high risk of developing it within the next decade, should consider cholesterol-lowering medication.

The United States Preventive Services Task Force (USPSTF) issued a recommendation statement in 2022 highlighting that adults aged 40 to 75 with cardiovascular risk factors (such as dyslipidemia, hypertension, diabetes, or smoking) and an estimated 10-year cardiovascular disease risk between 7.5 percent and 10 percent (as determined by a cardiovascular disease risk calculator) may benefit less from starting statin therapy. In such cases, statin therapy should be offered selectively. For those with a 10 percent or higher estimated 10-year risk, starting a moderate-intensity statin is recommended. However, for adults aged 76 and older, there is insufficient evidence to support or oppose starting statin therapy.

Additionally, people with a family history of cardiovascular disease and those with low-density lipoprotein (LDL) cholesterol levels exceeding 190 milligrams per deciliter (mg/dL) should also consider taking statin medication.

Cholesterol Testing

A blood test, typically preceded by an eight-to-12-hour fast, is required to determine cholesterol levels.

A blood test measures two types of cholesterol. One is high-density lipoprotein (HDL) cholesterol, which transports excess cholesterol from the blood to the liver, where it is broken down and excreted. The optimal level for HDL cholesterol is 60 mg/dL or higher.

Another type is low-density lipoprotein (LDL) cholesterol, often referred to as “bad” cholesterol, though this term is not entirely accurate because the body needs both types of cholesterol. LDL cholesterol transports fats to where they are needed in the body; however, elevated levels of LDL can increase plaque accumulation in the arterial walls. For healthy individuals, the optimal level should be below 100 mg/dL.

Another important indicator is blood triglyceride levels. Elevated triglyceride levels are often found in patients with heart disease, obesity, or diabetes. Typically, triglyceride levels should be below 150 mg/dL.

Role of Statin Medications

There are two sources of cholesterol in the blood: One is produced by the liver, which helps digest fatty foods and produce hormones, and the other comes from the diet, primarily from animal products such as dairy, eggs, meat, and poultry. Reducing dietary cholesterol can help lower blood cholesterol levels. However, some individuals may produce more cholesterol due to genetic factors, and others may absorb more from their digestive systems.

A healthy diet, anti-inflammatory measures, and regular exercise are crucial factors in lowering cholesterol. These lifestyle improvements should be made before resorting to cholesterol-lowering medication.

After conducting a blood test, cholesterol levels can be reduced by adjusting the diet and incorporating regular exercise. If these measures do not sufficiently lower cholesterol, statin medication can be considered. One study showed that moderate- and high-intensity statin therapy can reduce the risk of atherosclerotic cardiovascular disease by an average of 30 percent and 50 percent, respectively.

Statin medications primarily work in the following ways:

• Low-density lipoprotein (LDL) cholesterol can accumulate in the arteries, and statin medications help reduce LDL cholesterol levels in the blood.
• Plaques are common in most people’s arteries. Statin medications can stabilize these plaques, reducing the likelihood of detachment.
• Statin medications can help regulate cholesterol levels within cell membranes.
• Statin medications also exhibit anti-inflammatory and antioxidant effects.

Therefore, for patients already affected by atherosclerosis-related cardiovascular and cerebrovascular diseases, statin medications may play a significant role in prevention and treatment.

Side Effects of Statins

Medications, as foreign chemical substances, work by interfering with or even blocking the body’s normal physiological and biochemical processes. Statin medications, for example, work by inhibiting the enzyme in the liver that produces cholesterol. Such inhibition disrupts a normal physiological and biochemical response in the body, potentially leading to side effects.

After taking statin medications, up to 15 percent of people may experience muscle aches and weakness, and some may experience an increase in blood sugar. Therefore, for individuals in the prediabetic stage considering cholesterol-lowering medication, it is important to consider the potential side effects. Additionally, diabetes itself increases the risk of cardiovascular disease.

In addition to causing muscle aches, liver damage, and increasing the risk of Type 2 diabetes, statin medications may also lead to neurological side effects. The brain requires fats, and disruptions in their production and transport can lead to neurological issues. Specifically, statin medications can cause cognitive problems such as confusion and memory loss.

If symptoms are managed solely by medication, it is generally inadvisable to discontinue its use. However, if medication is used as temporary relief while concurrently improving lifestyle, diet, exercise, and stress reduction, it may be possible to gradually reduce or even cease the medication over time. Without lifestyle changes, symptoms are likely to recur after stopping the medication. Medications primarily serve to mask and alleviate symptoms rather than address the underlying causes of the disease.

Comprehensive lifestyle improvements are essential for managing high cholesterol. This includes adopting a healthier diet centered on low-sugar fruits and vegetables, whole grains, legumes, nuts, fish, and poultry, or following a Mediterranean or plant-based diet. Additionally, it is recommended to increase physical activity, avoid smoking, avoid alcohol, and manage weight and diabetes. By making these changes, medication may become unnecessary, or the dosage and duration of medication use can be reduced.

In summary, those with high cholesterol should develop a comprehensive lifestyle change plan based on their personal circumstances rather than relying solely on medication.

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.