Statins, medications that lower cholesterol, are widely used to reduce the risk of heart disease. They are effective at lowering total cholesterol and the bad cholesterol portion, known as LDL, which helps prevent heart attacks and strokes. Yet, many concerns about statin side effects persist, often fueled by misconceptions or misinterpretations. A cardiologist from the Department of Pharmacology and Clinical Pharmacology at a major medical faculty explained that some side effects are rare and that the real risk of intolerance is smaller than commonly believed.
High cholesterol remains a major risk factor for vascular events. Statins have demonstrated strong evidence of benefit in lowering cholesterol levels and in preventing serious heart and brain emergencies. Unfortunately, fears about adverse effects can lead doctors or patients to discontinue treatment without a solid medical reason, or to avoid starting therapy in the first place. The most frequently discussed adverse effects include muscle damage and muscle pain, and in rare cases, a condition called rhabdomyolysis, which involves the breakdown of muscle tissue and can lead to kidney problems.
The actual rate of statin intolerance is quite low. Myopathies and rhabdomyolysis are extremely rare occurrences, and many clinicians may go through their entire careers without encountering them in a single patient.
muscle pain is often not caused by the medication itself. Some studies have explored this phenomenon by comparing groups of people who received a statin with groups who received a placebo, without either the patients or the clinicians knowing who received which treatment. In those trials, the reported frequency of side effects, including muscle pain, was sometimes higher in the placebo group than in the statin group. This phenomenon is known as the nocebo effect: when people expect negative outcomes, they may report them regardless of whether the medication is active. In practical terms, this means that the true incidence of adverse effects from statins may be lower than expected by some patients and clinicians.
Another common myth is that statins cause liver damage. Liver enzymes should be checked before starting statin therapy, since severe liver failure is a contraindication to use. However, the medications themselves do not cause liver failure. It is also common to see a modest, clinically insignificant rise in liver enzymes within the first month after beginning statin therapy. For this reason, it is often recommended to monitor liver tests about four weeks after starting treatment, and then periodically thereafter based on individual risk and response.
Concerns about erectile dysfunction are also common. Early discussions suggested possible links between statin use and sexual performance, but evidence shows that statins do not worsen erectile function in most cases. In fact, atherosclerotic damage to the vessels supplying the penis can impair blood flow and contribute to erectile dysfunction. By slowing the progression of atherosclerosis, statins can help preserve vascular health and support normal erectile function in many individuals.
In the broader conversation about lowering cholesterol, it’s important to consider lifestyle measures in combination with medication. Diet, physical activity, weight management, and smoking cessation all play significant roles in controlling cholesterol levels. For some individuals, these lifestyle changes may reduce the need for medication, while for others, statins remain a critical tool in lowering cardiovascular risk. The key is to have open, ongoing conversations with healthcare providers, weigh benefits and potential risks, and make decisions based on personal health profiles and goals.
Ultimately, the evidence supports the effectiveness of statins in preventing heart attacks and strokes for many people with high cholesterol. While nothing is without risk, the most common side effects are rare and often driven by factors other than the drug itself. Patients who experience new or unusual symptoms should consult their clinician promptly to determine whether changes in therapy are warranted or whether the symptoms are due to non-medication factors. A careful, individualized approach helps ensure that cholesterol can be managed safely and effectively, reducing the likelihood of future vascular complications.