Written and medically reviewed by Dorcas Morak, Pharm.D
September's National Cholesterol Education Month is the perfect reminder to learn more about one of the most effective ways to lower cholesterol and protect your heart. Statins are among the most commonly prescribed medications in the United States, yet many people don't fully understand how they work, who benefits from them, or what side effects to expect. Here's what you should know about statin therapy and how to save on your prescriptions.
What Are Statins and How Do They Lower Cholesterol?
Statins lower cholesterol by blocking an enzyme in the liver called HMG-CoA reductase, which the body uses to produce cholesterol. This helps reduce levels of low-density lipoprotein (LDL), often called "bad" cholesterol, slowing plaque buildup in the arteries and lowering the risk of heart attack and stroke.
In addition to lowering LDL cholesterol, statins may help stabilize existing plaque, making it less likely to rupture and cause a heart attack or stroke.
Which Statin Medications Are Most Commonly Prescribed?
Several statins are available, and your healthcare provider will choose the one that's best suited to your medical history and cholesterol goals. Common statins include:
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Pravastatin (Pravachol)
- Lovastatin (Mevacor)
- Fluvastatin (Lescol)
- Pitavastatin (Livalo)
Many of these medications are available as lower-cost generic versions that provide the same active ingredient and effectiveness as their brand-name counterparts.
Who Should Take a Statin?
Current cardiovascular prevention guidelines recommend statins based on a person's overall risk for heart disease rather than cholesterol numbers alone. Healthcare providers often consider your age, LDL cholesterol level, blood pressure, diabetes status, smoking history, family history, and risk assessment tools such as the PREVENT calculator when deciding whether statin therapy is appropriate.
Many people at higher risk benefit from LDL cholesterol levels below 70 mg/dL, while individuals at very high risk may have even lower treatment goals.
What Are the Most Common Statin Side Effects?
Most people take statins without significant side effects. The most commonly reported side effect is muscle aches or soreness, which often improves by lowering the dose or switching to a different statin. Less commonly, statins may increase liver enzymes or, in rare cases, cause a serious muscle injury called rhabdomyolysis that requires immediate medical attention.
Contact your healthcare provider promptly if you develop severe muscle pain, weakness, dark-colored urine, or unexplained fatigue.
Do Statins Increase the Risk of Diabetes?
Statins have been associated with a small increase in blood sugar levels and a modest increase in the risk of developing type 2 diabetes, particularly in people who already have diabetes risk factors.
For most patients, however, the reduction in heart attack and stroke risk far outweighs this small increase in diabetes risk. Your healthcare provider can help determine the right treatment plan based on your overall health.
What Blood Tests Are Needed While Taking Statins?
Before starting treatment, your healthcare provider will usually order a lipid panel and may obtain baseline liver function tests.
After starting a statin or changing the dose, a repeat lipid panel is typically performed within 4 to 12 weeks to ensure the medication is working effectively. Routine liver function testing is no longer recommended for everyone but may be repeated if you develop symptoms such as unusual fatigue, weakness, abdominal pain, or yellowing of the skin or eyes.
What Happens If Statins Don't Lower Cholesterol Enough?
If your LDL cholesterol remains above your treatment goal despite taking the highest tolerated statin dose, your healthcare provider may recommend adding another medication. Common options include:
- Ezetimibe (Zetia)
- Bempedoic acid (Nexletol)
- PCSK9 inhibitors such as evolocumab (Repatha) or alirocumab (Praluent)
These medications work differently from statins and may provide additional LDL cholesterol reduction for people at higher cardiovascular risk.
Can Lifestyle Changes Replace Statins?
Healthy lifestyle habits remain one of the most important parts of managing cholesterol.
Following a Mediterranean-style or DASH eating plan, eating more fruits, vegetables, whole grains, and soluble fiber, limiting saturated fats, exercising regularly, maintaining a healthy weight, and avoiding tobacco products can all help improve cholesterol levels.
For many people with elevated cardiovascular risk, however, lifestyle changes work best alongside statin therapy rather than replacing it.
Can You Drink Grapefruit Juice While Taking a Statin?
It depends on which statin you're taking. Grapefruit and grapefruit juice can increase blood levels of certain statins, including simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor), potentially increasing the risk of side effects.
Other statins, including rosuvastatin (Crestor) and pravastatin (Pravachol), are generally not affected. If you regularly consume grapefruit products, ask your healthcare provider or pharmacist whether your medication could interact.
Should You Take a Statin in the Morning or at Night?
Some statins are best taken in the evening because the body produces most of its cholesterol overnight.
Shorter-acting statins, such as simvastatin (Zocor) and pravastatin (Pravachol), are often recommended at night. Longer-acting statins, including atorvastatin (Lipitor) and rosuvastatin (Crestor), can generally be taken at any time of day.
No matter which statin you take, taking it consistently at the same time each day helps improve adherence.
What Happens If You Stop Taking a Statin?
Stopping a statin without talking to your healthcare provider allows LDL cholesterol levels to gradually rise back toward previous levels, reducing the medication's protective benefits over time.
If you're experiencing side effects or having trouble affording your medication, don't stop treatment on your own. Talk with your healthcare provider about adjusting your dose, switching medications, or exploring lower-cost options.
How Can You Save Money on Statin Medications?
Many statins—including atorvastatin, rosuvastatin, simvastatin, and pravastatin—are available as affordable generic medications. However, prices can still vary significantly between pharmacies.
The RxLess® Assurance Plan offers free digital coupons and real-time prescription price comparisons at more than 70,000 pharmacies nationwide, helping eligible patients save up to 88% on many prescription medications, including commonly prescribed generic statins.
Simply download the free RxLess® app from the Apple App Store or Google Play to automatically become a member of the RxLess® Assurance Plan and start comparing prescription prices before you fill your next prescription.
