Should I be taking a statin for my high cholesterol?

For those who have researched it on the internet, this might be a frustrating question. Let’s make it easy. Statins are a very useful tool that can be extremely helpful for specific patients, but they do have side effects and can sometimes be avoided. A good place to start any discussion on this topic is by dispelling some myths about cholesterol.

Myth #1: Your high cholesterol comes from cholesterol in your diet.

Truth: For most people, high cholesterol does not come from cholesterol in your diet. Only about 20% of cholesterol in your body comes from cholesterol taken in through your diet. The vast majority of cholesterol in your body is produced by your own liver. Your body makes LDL cholesterol out of saturated fats you consume in your diet, usually from animal fats like meats, cheeses, butter, and other full fat dairy. So, the way to reduce your cholesterol through diet is to eat foods that are low in saturated fat, not to avoid cholesterol containing foods.

Myth #2: Cholesterol is bad.

Truth: You probably know about “good cholesterol,” or HDL, and “bad cholesterol,” aka LDL. It is true that HDL promotes health and that a higher number is better. But, even LDL is not “bad.” In fact, LDL cholesterol is necessary for good health, or your body would not make it! Your body uses it for energy, making important hormones, and for maintaining your brain and nervous system, among other things.

It is key to understand why SOME high cholesterol is a problem. Most people who are concerned about cholesterol were told by their doctors that their LDL was high. The simplified theory is that this kind of cholesterol causes heart attacks and strokes. In truth, doctors should not be focusing so much on the LDL number. LDL is an imperfect marker of risk of future heart attack and stroke. What we really care about is how many LDL particles you have in your bloodstream, how small they are, and whether they are being oxidized (by inflammation) or glycated (by high blood sugar).

Smaller LDL particles are more dangerous, because they can enter the wall of the blood vessel. Small LDL particles that have been oxidized or glycated are the real worry, because they cause inflammation when they get into the blood vessel wall. This process can lead to the development of a blockage that could lead to heart attack or stroke.

Myth #3: If your LDL cholesterol is high, you need to take a statin to lower it.

Truth: When your doctor says, “You need to go on a statin because your LDL is high,” this may be an easy way to take care of large numbers of patients without digging into their individual situations, but is often premature for many individuals. To make this decision, we need to know more. Fortunately, it is not difficult or expensive to get that information. There are more advanced tests that are better predictors of heart attack and stroke risk, such as the test for apolipoprotein B (ApoB). If the LDL is high and the ApoB is in the safe range, you probably can start addressing the situation with lifestyle modifications under the treatment of your doctor, rather than jumping right to taking a statin.

Another useful test to better know your risk is the Lp(a) test (“lipoprotein little a”). At RISE, we recommend an Lp(a) test be performed on everyone at some point in their lives. This test is rarely performed by doctors in the US, but it is inexpensive and high levels of Lp(a) significantly increase your risk of future heart attack and stroke. If your Lp(a) is elevated and we can not get it down with lifestyle modifications and targeted supplements, you definitely will need to take a statin or other cholesterol lowering medicine. Other useful tests include the hemoglobin A1C, which tells how high your blood sugars are, and the myeloperoxidase test (MPO), which measures how much of the cholesterol has been oxidized.

Myth #4: If I’m exercising regularly I don’t need to worry about my cholesterol.

Truth: Regular exercise will do wonderful things, like improve your mood and energy level, increase muscle mass, improve your metabolism, raise your HDL, and lower your triglycerides (fats in the blood). But exercise may have only a mild impact on things like your LDL, ApoB, or Lp(a). The most likely exercise to help is HIIT training, so we recommend reading our post on those workouts.

Take Home: Before starting a statin, consider these cholesterol facts and discuss the decision with your doctor. For our patients, we take a personalized approach. We consider genetics, diet, metabolism and personal preferences and values to arrive at a plan that works for you specifically. We have a number of dietary and supplement-based approaches we employ that, thankfully, help most of our patients get their cholesterol into the optimal range while staying off of statins and avoiding the downstream, undesirable effects.