Why Aren't More People Taking Statins Despite Their Ability to Prevent Heart Attacks and Strokes?

New research indicates that many adults who could utilize statins to avoid cardiovascular disease are not doing so.

It is estimated that 86 million U.S. adults aged 20 years and older have high cholesterol, i.e., total cholesterol levels above 200 mg/dL. This is a risk factor for both heart disease and stroke. Statins can help by decreasing cholesterol production in the liver and thus decreasing overall blood cholesterol.

However, according to the new study published in the Annals of Internal Medicine, only about 35% of adults who qualify for statin use are actually using them. Moreover, those who would benefit most from these medications, such as those with diabetes, extreme high cholesterol, or a 10-year risk of cardiovascular disease greater than 20%, are not receiving them.

This is despite the 2013 guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) which extended eligibility for statin use for primary prevention in high-risk individuals.

Study lead author Timothy Anderson, MD, assistant professor of medicine at the University of Pittsburgh, acknowledges that not everyone who is eligible will use preventative treatments like statins, but he expected to see an increase over time. However, their research shows that the use of statins has plateaued since 2013.

The study also shed light on the issue of low statin uptake for the primary prevention of cardiovascular disease, the reasons why people often choose not to use statins, and who stands to gain the most from the medication.

There are several reasons why individuals may avoid statins, a skepticism that dates back to when the drugs were first introduced. According to Stephen Kopecky, MD, a cardiologist and director of the Statin Intolerance Clinic at the Mayo Clinic, patients’ suspicion of statins has increased over the years since their introduction in 1987. Part of this suspicion is due to unclear communication about side effects, such as muscle aches, by the drug manufacturers.

In addition to muscle aches, statins have been linked to an increase in blood sugar and interference with insulin production, potentially leading to an increased risk of diabetes. Anderson noted that other barriers include limited access to primary care and misinformation about LDL cholesterol and statins, particularly on social media, which may have contributed to the lack of increase in statin usage.

Research supports these claims, as a study employing artificial intelligence (AI) identified that nearly one-third of more than 10,000 statin-related posts on social media displayed negative views of statins. However, Kopecky stresses the complexity of LDL cholesterol beyond its commonly held bad reputation.

The potential benefits of statin use largely depend on an individual’s risk of experiencing a heart attack or stroke. Statins may help prolong and improve the lives of those who have previously had a heart attack or stroke, those diagnosed with diabetes or high cholesterol, and those with an increased risk due to high blood pressure.

Healthcare professionals can gauge a patient’s risk using an atherosclerotic cardiovascular disease (ASCVD) risk calculator. This tool predicts patients' 10-year risk of experiencing a heart attack, incorporating details like age, blood pressure, and cholesterol levels, along with other health data. Anderson claims this score informs the strength of their recommendation for statin use.

Aside from statin use, lifestyle modifications like changes in diet, exercise, stress reduction, and, where applicable, quitting smoking or losing weight, can also benefit those at elevated risk of cardiovascular disease and high cholesterol.

“Cholesterol is in every plaque that we have in our arteries to our heart and it catches up to you later in life,” Kopecky said. If you intervene early, when the problem is more manageable, “you can really take care of it.”