Many patients are surprised when their doctor recommends statin therapy for high cholesterol, especially if they feel healthy or believe their diet is not high in cholesterol. Dr. Jacob Symington, a primary care physician at Houston Methodist, explains that cholesterol levels and heart disease risk are influenced by more than just dietary intake.
“I do get that a lot,” says Dr. Symington. “But diet is only part of the story. And if your cholesterol is high, or if your 10-year risk of heart attack or stroke is high, you likely won’t have symptoms until it’s too late.”
Statins are medications designed to reduce the production of cholesterol in the liver, which lowers overall blood cholesterol levels. Commonly prescribed statins include atorvastatin, rosuvastatin, simvastatin, pravastatin, and lovastatin. The choice of medication depends on individual cardiovascular risk factors and how well the patient tolerates the drug.
Dr. Symington notes that many people mistakenly attribute high cholesterol solely to eating foods rich in cholesterol. “It’s more about the carbohydrates we eat,” he says. “Sugary foods, simple carbs — these are eventually converted into cholesterol once broken down in the body.”
Other factors contributing to elevated cholesterol and increased heart disease risk include diets high in ultra-processed foods, lack of physical activity, being overweight, smoking, and aging. Over time, these factors can lead to plaque buildup in arteries—a condition called atherosclerosis—which increases the risk for coronary artery disease and cerebral artery disease.
“Atherosclerosis can also lead to peripheral artery disease, which can cause leg pain when walking,” adds Dr. Symington.
The decision to start statin therapy is based on a calculated 10-year risk of developing atherosclerotic cardiovascular disease (ASCVD), which includes heart attack, stroke, and peripheral artery disease risks.
“This calculation takes into account cholesterol levels, blood pressure, whether you smoke, whether you have diabetes, your age and more,” says Dr. Symington. “From this, it provides a percentage risk of heart attack or stroke over the next ten years.”
He adds: “And if your LDL cholesterol is over 190, we automatically want you on a statin.”
The main goal of using statins is not just lowering lab values but preventing serious health events such as heart attacks and strokes over time.
“The big reason we use these medicines at all is to lower the risk of heart attack and stroke,” says Dr. Symington. “Over a period of 5, 10, 15 years, that risk is lowered considerably.”
While statins are generally safe for most people according to Dr. Symington—muscle aches may occur but are often manageable by switching medications; mild elevations in liver enzymes can happen but rarely indicate significant damage; there is also an increased but low risk for developing type 2 diabetes with statin use.
“The literature shows very clearly that the benefit of reduced heart attack and stroke risk outweighs any transient impact on the liver,” reassures Dr. Symington.
“There is an increased risk of developing diabetes with statin medications,” he acknowledges but emphasizes: “The decreased risk of cardiovascular disease with statins outweighs the risk of developing diabetes because that risk is low — and you still see an overall decrease in cardiovascular disease and death from all causes despite the small risk of diabetes.”
Lifestyle changes remain important both before starting medication and alongside it: regular exercise (150 minutes per week), eating whole foods while reducing simple carbs and saturated fats intake; maintaining healthy weight; quitting smoking—all contribute positively to lowering cholesterol levels.
“Especially if cholesterol elevation is mild or heart attack-stroke risk isn’t high, your doctor may recommend first trying exercise and diet before prescribing a statin,” says Dr. Symington.
“A lot of times the plan I come to with patients is: try this for three or six months. And if we don’t see things heading in the right direction I’d like us to try a statin,” he adds.
If recommended by a physician based on calculated long-term risks rather than marginally elevated numbers alone—statins serve as one tool among several for protecting future health outcomes related to cardiovascular events.
As Dr. Symington concludes: If unsure about recommendations regarding statin therapy patients should ask their doctors for clarification about personal risks since combining lifestyle adjustments with medication often yields best results.
