Along with recommendations for a heart-healthy diet and exercise regimen, a statin medication is commonly prescribed to lower cholesterol and reduce heart disease risk. Statins can be lifesaving for some people and have been shown to help improve some cardiovascular disease outcomes.

Statins are a class of medications that work to lower your cholesterol, which can reduce your risk of a stroke or heart attack. They work by blocking the enzyme that makes cholesterol and reabsorbing existing cholesterol in the blood, putting it to use in the body. Less cholesterol accumulates in the blood, reducing the risk of plaque buildup in the arteries.

If your doctor recommended starting a statin, you may have some questions, such as if there are any potential side effects for statins, or you may ask yourself, “Are statins safe?”  I’ll answer these questions and more in this article.

15 Common Questions About Statins

Statins are commonly prescribed medications for heart health, but that doesn’t mean everyone knows everything about them. Here are 15 frequently asked questions to help you better understand statins. 

1. What are the side effects of statins?

Statins are generally safe, but there are possible side effects. These can vary depending on the type of statin:

• Headache
• Dizziness
• Nausea
• Weight gain
• Weakness and fatigue
• Digestive upset
• Muscle pain
• Food interactions
• Increased blood sugar
• Memory loss
• Reduced mood and feelings of depression
• Neuropathy on the legs

Out of these side effects, the most common is muscle pain and weakness.

There is a possible link between statins and diabetes risk in those who already have prediabetes or diabetes. It’s thus essential to weigh out the pros and cons of taking a statin with your doctor.

Memory loss is a reported side effect of statins, but most reports mention it is temporary and typically resolves after coming off the statin. However, many people are prescribed statins for their whole life, thus this can be a potential concern.

Everyone responds differently to the dose or intensity of the statin. For example, if you are experiencing side effects on a high-intensity statin, switching to a moderate-intensity statin or low-intensity statin may be discussed with your doctor.

Lastly, some people are statin intolerant and more likely to experience side effects, like increased liver enzymes or more severe muscle pain (myopathy). In this case, your doctor may recommend decreasing the dose or switching to a different statin or medication altogether.

2. Why do statins cause muscle pain?

Muscle pain that is sometimes experienced with statins may be caused by decreased muscle growth and the breakdown of muscle fibers. Statins may also decrease coenzyme Q10 (CoQ10) levels in the body, a substance that helps your muscles produce energy. When this happens, you may be more likely to experience myopathy (which some research indicates may be alleviated with CoQ10 supplementation). 

3. Do statins make you hungry?

While increased hunger isn’t a typical side effect of statins, some people do report changes in appetite or weight gain while taking them. However, this isn’t common and may vary between people. 

If you notice significant changes in hunger or weight while taking statins, it’s best to discuss this with your healthcare provider to rule out any other underlying causes.

4. Do statin drugs cause weight gain?

Statins may cause weight gain in some people both directly and indirectly. Research shows certain statins decrease leptin levels, the hormone responsible for keeping us full. Due to this side effect, some people may find themselves hungrier or need to eat more to feel satisfied.

They may also indirectly cause weight gain by providing a false sense of security that you do not need to watch your diet, which can lead to overeating. 

5. Are there natural statin alternatives?

These are 3 of the most common natural statins on the market to lower cholesterol.

• Phytosterols – These are plant compounds that act similarly to statins in the body. They prevent cholesterol absorption and are in foods like whole grains, nuts, fruits, and vegetables. Food manufacturers also are adding phytosterols to yogurt and margarine, and they are also available as supplements. One study showed taking 2 grams of phytosterols per day can lower LDL cholesterol by up to 8-10%.
• Fish oil – Taking fish oil or eating fatty fish like salmon, tuna, sardines, or anchovies can increase HDL cholesterol (the “good: cholesterol) levels that protect the heart. However, fish oil may also modestly increase LDL (the “bad” cholesterol) in these same studies, which doesn’t make it a viable natural statin option.
• Red yeast rice – Red yeast rice is a fermented rice that has been associated with decreased cholesterol levels. It often contains a compound called monacolin K that was previously found in statins. This ingredient was seen to cause liver damage, and so now any red yeast rice containing more than trace amounts of it has been taken off the market. And since monacolin K is the ingredient said to provide cholesterol-lowering benefits, without it it is likely not effective. 

Red yeast rice is considered a supplement, and so it is less heavily regulated than medications like statins. Because of this, there is no way of knowing how much monacolin K is present in most red yeast rice products, and thus taking them poses a potential risk. 

It is therefore advised to not take red yeast rice in supplement form unless prescribed by your medical team and liver enzymes are monitored closely.

Always speak to your doctor and cardiology dietitian before starting any natural statins or supplements, especially if you are already taking a statin.

6. What about statins and alcohol?

Alcohol does not directly interact with statins, but it serves no cardiovascular benefit. Heavy drinking combined with statins can put more strain on the liver. It also increases the risk of statin-induced myopathy or severe muscle pain. 

If you’re taking a statin, abstain from alcohol or stick to one alcoholic drink per sitting for women and men, and not every day. 

7. Is there a link between statin drugs and dementia?

Statins may lead to confusion or memory loss, but at this time do not appear to lead to dementia. Most studies have not found statin use to increase diagnosed dementia risk, and some have found a reduced risk. 

8. How much CoQ10 should I take with statins?

There is some research on CoQ10 and statins, and how supplementing with CoQ10 may reduce statin-associated muscle pain. Other studies, however, show no benefit. The recommended dosage varies from 30-200 mg of CoQ10 per day and should be discussed with your medical team. If taking a CoQ10 supplement, it is important to note that it is a fat-soluble vitamin and should be consumed with food for optimal absorption.

9. Can a statin lower blood pressure?

Statins can lower blood pressure levels, especially if you already have high blood pressure. It’s important to keep in mind that this reduction in blood pressure is typically only reduced by 2-3 points, a relatively small amount.

10. What is considered a high-intensity statin?

A high-intensity statin is a dose of statin medication that lowers LDL by 50% or more. These statins are typically prescribed for people at high risk of cardiovascular events, such as those who have had a heart attack or stroke, or who have very high cholesterol levels. 

If you’re wondering, if 40 mg statin is a high dose, yes. The most common high-intensity statins include atorvastatin (Lipitor), prescribed in doses of 40 to 80 mg daily, and rosuvastatin (Crestor), prescribed in doses of 20 to 40 mg daily.

11. What is considered a low-dose statin?

If you need to lower your LDL by 30%, especially if you are committed to doing so with improvements to your diet, this can often be done with a low-dose statin (plus diet) of 5mg. Many of my clients take this approach. 

Common low-dose statins include:

• Simvastatin (Zocor), 10 mg daily
• Pravastatin (Pravachol), 10 to 20 mg daily
• Lovastatin (Mevacor), 20 mg daily
• Fluvastatin (Lescol), 20 to 40 mg daily

12. Can I take lisinopril with statins?

Lisinopril is an ACE inhibitor used to treat high blood pressure and heart failure. It can generally be taken with statins as there are no known significant drug interactions between them. These medications are often prescribed together for patients who have both high blood pressure and high cholesterol or those at risk for cardiovascular disease. 

Still, not every prescription combination is appropriate for every person, so be sure to follow the guidance of your healthcare provider. 

13. Do grapefruit and statins mix?

Grapefruit and statins may interact, as grapefruit contains chemicals called furanocoumarins that can prevent the statin from being broken down. It can dangerously increase the amount of statin in your blood, leading to a rare, but serious side effect called rhabdomyolysis that can damage the heart and kidneys. 

In addition to grapefruit, pomegranates also contain furanocoumarins. But only certain statins interact with these foods, so this is an important question to ask your cardiology dietitian or doctor.

14. What are the most common statins?

Statins vary in potency and are often prescribed based on individual needs, including risk of heart disease, cholesterol levels, and tolerance for side effects. Some of the most common statins are:

• Atorvastatin (Lipitor) 
• Rosuvastatin (Crestor) 
• Simvastatin (Zocor)
• Pravastatin (Pravachol) 
• Lovastatin (Mevacor) 
• Fluvastatin (Lescol)

15. I don’t want to take statins. What else can I do to improve my heart health?

Despite the benefits of statins, you may be still asking yourself, “What can I take instead of statins to lower cholesterol?” Practicing a healthy lifestyle and following a science-based heart-healthy diet and exercise routine can have a huge impact on your cardiovascular disease risk. 

It may be helpful to meet with a cardiology dietitian to help create a personalized plan to help you achieve your goals, whether that is to lower your atherogenic LDL cholesterol, your apoB, your non-HDL cholesterol, and/or stabilize or prevent plaque from forming in the arteries and reduce your risk of a heart attack and stroke. 

It’s also imperative to closely monitor your labs, including ApoB and non-HDL cholesterol, so you don’t miss high levels that can cause the silent buildup of arterial plaque. 

Whether you decide to take a statin or not, it is not a free pass to ignore your diet or forgo your exercise routine.

Be Your Own Heart Health Advocate

Statins can be an effective tool to support your heart health, but each person has individual needs. If you have questions about statins, don’t be afraid to ask your doctor and supportive cardiology team. Be proactive, write down a list of questions, and seek the input of not only your doctor but of a Registered Dietitian who specializes in heart health. 

With my background as a cardiology dietitian, I provide individualized and group guidance on building healthy lifestyle habits that protect your heart. I have successfully helped thousands of clients reduce their risk of heart attacks and strokes by optimizing their risk profile and their laboratory values using personalized, science-based nutrition. 

If you’re interested in working together to improve your heart health and reduce your risk of cardiovascular complications, feel free to enroll in my next 6-week heart optimization group program here, or contact me for a 15-minute consultation call for my 1 on 1 services.

Be sure to sign up to my email list for my monthly heart disease prevention guides and tips to protect your heart.

References

1. Alonso R, Cuevas A, Cafferata A. Diagnosis and Management of Statin Intolerance. J Atheroscler Thromb. 2019;26(3):207-215. doi:10.5551/jat.RV17030
2. Reith, Christina et al. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. The Lancet, Volume 400, Issue 10355, 832 – 845
3. Qu H, et al. (2018). Effects of Coenzyme Q10 on Statin‐Induced Myopathy: An Updated Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association, 7(19). https://doi.org/10.1161/JAHA.118.009835 
4. Singh P, Zhang Y, Sharma P, et al. Statins decrease leptin expression in human white adipocytes. Physiol Rep. 2018;6(2):e13566. doi:10.14814/phy2.13566
5. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Red Yeast Rice. [Updated 2018 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548168/
6. National Center for Complementary and Integrative Health. Red Yeast Rice: What You Need To Know. Retrieved from: https://www.nccih.nih.gov/health/red-yeast-rice
7. Simakova MN, Bisen S, Dopico AM, Bukiya AN. Statin therapy exacerbates alcohol-induced constriction of cerebral arteries via modulation of ethanol-induced BK channel inhibition in vascular smooth muscle. Biochem Pharmacol. 2017;145:81-93. doi:10.1016/j.bcp.2017.08.022
8. Olmastroni, E., Molari, G., De Beni, N., Colpani, O., Galimberti, F., Gazzotti, M., Zambon, A., Catapano, A. L., & Casula, M. (2022). Statin use and risk of dementia or Alzheimer’s disease: A systematic review and meta-analysis of observational studies. European Journal of Preventive Cardiology, 29(5), 804-814. https://doi.org/10.1093/eurjpc/zwab208
9. Littlefield N, Beckstrand RL, Luthy KE. Statins’ effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation. J Am Assoc Nurse Pract. 2014;26(2):85-90. doi:10.1002/2327-6924.12046
10. Taylor BA, Lorson L, White CM, Thompson PD. A randomized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis. 2015;238(2):329-335. doi:10.1016/j.atherosclerosis.2014.12.016
11. Bautista LE. Blood pressure-lowering effects of statins: who benefits?. J Hypertens. 2009;27(7):1478-1484. doi:10.1097/HJH.0b013e32832b1e78
12. Strazzulo P, et al. Do Statins Reduce Blood Pressure?: A Meta-Analysis of Randomized, Controlled Trials. Hypertension, 49(4). https://doi.org/10.1161/01.HYP.0000259737.43916.42
13. Lee JW, Morris JK, Wald NJ. Grapefruit Juice and Statins. Am J Med. 2016;129(1):26-29. doi:10.1016/j.amjmed.2015.07.036

National Institute for Occupational Safety and Health (NIOSH). CDC. gov. Rhabdomyolysis and Work. Retrieved from: https://www.cdc.gov/niosh/rhabdo/about/?CDC_AAref_Val=https://www.cdc.gov/niosh/topics/rhabdo/