Jun 15, 2023
What are statins and who should take them?
If you are over 40 and at risk of heart disease, your primary care provider may have recommended you take a statin, one of the most common prescriptions for adults in the U.S.
But what do statins do, and who should consider taking one?
“Statins are important preventive drugs for cardiovascular events – such as a heart attack or stroke – and are one of the biggest advances in cardiovascular health in recent decades,” said Dr. Ben Kruskal, a physician who is a medical director at the state’s largest not-for-profit health plan, Blue Cross Blue Shield of Massachusetts.
How do statins work?
Statins, commonly taken as a daily pill on a long-term basis, can reduce risk for people who have had a heart attack, stroke or other cardiac event or are at an increased risk for having one, Kruskal said.
They can work by:
- Reducing the amount of cholesterol made in the liver
- Lowering “bad” plaque-causing cholesterol in the blood
- Reducing the buildup of plaque on the walls of your arteries
- Stabilizing plaque so that it doesn’t break off and block blood flow to the heart or brain
- Decreasing swelling in the walls of your arteries
- Decreasing the chance of blood clots forming
While lifestyles changes such as eating healthy foods and exercising can provide cardiovascular benefits to patients, they are not as robust as the benefits statins offer, Kruskal said.
Source: Centers for Disease Control and Prevention (CDC)
What if you have side effects?
“Statins can have a few side effects that are mostly tolerated, such as muscle aches and soreness,” Kruskal noted. “If you start having muscle aches after taking a statin, you should talk to your doctor about decreasing your dose, changing how you take your medication, or switching to a different statin.”
In general, research has found, people who take statins don’t experience any more discomfort than people taking a placebo. And more than 70% of people who temporarily discontinue statins due to side effects are later able to find a regimen that works for them.
In rare cases, Kruskal said, statins pose a risk of liver problems. “You should discuss any pre-existing liver problems with your doctor and get regular blood work to monitor your liver function.”
A discussion with your PCP
Kruskal advises at-risk patients to have a conversation with their primary care provider about whether they should take statins.
There are some people for whom a statin is highly recommended -- for instance, those who have had a prior cardiac event or have a history of heart disease
“Patients should talk to their physician and come to a shared decision about whether to take one. For instance, patients with high cholesterol, high blood pressure, diabetes or who smoke may benefit from taking a statin.”
Notably, Kruskal said, “cardiovascular diseases manifests differently in women than in men,” and women may not realize they could benefit from a statin’s cardiovascular protection.
Like many conditions and treatments, racial inequities exist among those with heart disease and those who take statins.
“Due to structural racism, Black Americans are more likely to have cardiovascular disease than white Americans, and there are also large racial inequities in the quality of care for cardiovascular conditions, as our own public equity report shows,” said Dr. Mark Friedberg, an internist and senior vice president of performance measurement and improvement at Blue Cross.
Data reflecting claims for 1.2 million Blue Cross Blue Shield of Massachusetts members shows that statin use among Black members with cardiovascular disease is 16% lower than among their white counterparts, and statin use among Black members with diabetes is more than 20% lower than their white counterparts.
Blue Cross is working to address and eliminate these and other health inequities on several fronts, Friedberg noted, through groundbreaking payment models with providers that link financial incentives to improvements in health equity, $25 million in grants for 13 of the state’s largest provider organizations to fund solutions to tackle health inequities, and a learning community where hospitals and physicians can share best practices.
We know many of these inequities are deeply rooted, and we are committed to working with the medical community to find solutions to eliminate them, with the goal of creating a more equitable health care system for all patients.
Dr. Mark Friedberg