What's the Story on Cholesterol & Statins?

Learn the difference between LDL and HDL cholesterol and the health benefits of statins

A smiling middle-aged man pauses in a sun-filled hospital corridor with trees visible in the background

by Matthew Lucks, MD

You’ve probably seen the television commercials for cholesterol-lowering medications — the ones that talk about how high cholesterol can come not only from some foods you eat, but from relatives dressed in silly outfits, too.

Though the costumes are funny, the message is serious: high cholesterol can be a significant risk factor for heart disease. And for the right patients, these medications, called statins, can help reduce cholesterol and lower the risk for heart disease.

Is cholesterol good or bad?

The short answer is: both. It’s normal to have some cholesterol; in fact, the soft, waxy substance found in the blood and cells helps build cell membranes and contributes to other body functions.

There are two types of cholesterol: LDL or “bad” and HDL or “good” cholesterol. HDL cholesterol is good because high levels of it appear to protect your heart. LDL cholesterol, on the other hand, can clog your arteries and is a major risk factor for heart disease, heart attack and stroke.

Your body makes LDL cholesterol naturally, but a diet high in saturated or trans-fats encourages your body to produce too much of it. Additionally, you may inherit genetic factors that send LDL production into overdrive.

That’s where statins come in. While some people can control their cholesterol through diet and exercise, others may need medication to get back to healthy levels.

Benefits of statins

In the United States, total cholesterol has dropped to an average of under 200, which is the goal for many people. We attribute this drop mostly to the increased use of statin medications by people age 40 and older.

Many physicians now consider these medications the standard of care for patients trying to lower their LDL cholesterol levels. In fact, a series of studies has shown that statins have other beneficial effects in addition to cholesterol control.

Statins are thought to help reduce the harmful build-up of plaque in the arteries. In addition, they may have anti-inflammatory properties; research suggests that inflammation may be a key factor in heart disease.

Who should take statins?

We consider several factors, including medical history, lifestyle and other risk factors, when determining whether a patient with high cholesterol is a good candidate for statin therapy. Generally, if a patient cannot reach his or her cholesterol goal through dietary changes and exercise (simply taking a brisk walk most days of the week can help), we recommend adding a statin medication to their treatment.

Some people don’t want to take statins because they feel they should be able to control their cholesterol themselves through diet and exercise. But in some cases, factors such as genetics or diabetes may make this impossible even if they are doing all the right things. In addition, if a patient is close to his or her cholesterol goal but has already had a heart attack, we would recommend statin therapy.

Others are reluctant to take statins because they are concerned about potential side effects such as liver problems and muscle aches. In reality, these side effects are not common, and if they do occur, we simply discontinue the medication.

If your physician recommends a statin medication, let him or her know if you have concerns. Often, I compromise with my patients: I will recommend they use statins until they reach their cholesterol goal, and when they do, they can stop the statins and try to maintain their cholesterol with diet and exercise. If they can, great! If not, we know statin therapy is the right solution.

This Scripps Health and Wellness information was provided by Matthew Lucks, MD, a cardiovascular disease specialist at Scripps Memorial Hospital, La Jolla.