Statins are among the most studied medicines in the world, and also among the most debated at the kitchen table. Many people are unsure whether they need one, and many who take one wonder whether their aches are coming from the pill. This article covers who benefits under current guidance and what large trials say about side effects.

What statins do

Statins lower LDL, the “bad” cholesterol, by slowing how much cholesterol the liver makes and helping it clear LDL already in the blood. MedlinePlus, from the National Library of Medicine, notes that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. They are usually taken once a day for the long term.

Who should consider one: the 2026 guideline

In March 2026, the American College of Cardiology, the American Heart Association and nine other groups published a new guideline on the management of dyslipidemia, replacing the 2018 cholesterol guideline. For people who have not had a heart attack or stroke, the key changes are:

  • Risk is estimated with the AHA’s newer PREVENT equations, for adults aged 30 to 79.
  • Cholesterol-lowering therapy can be considered at a 10-year risk of 3 to under 5 percent, and should be considered at 5 to under 10 percent, after a conversation between you and your clinician.
  • For adults 40 to 75 with diabetes, stage 3 or 4 chronic kidney disease, or HIV, therapy is recommended regardless of LDL level.
  • LDL and non-HDL cholesterol goals are back, and lipoprotein(a) should be measured at least once.
  • After 75, treatment can be considered along with lifestyle changes.

The guideline also endorses a coronary artery calcium scan for men 40 and older and women 45 and older when the decision is uncertain. We explain that test in coronary artery calcium score, and lipoprotein(a) in ApoB and Lp(a).

The U.S. Preventive Services Task Force uses older thresholds. Its 2022 recommendation advises a statin for adults 40 to 75 with at least one risk factor (high cholesterol, diabetes, high blood pressure or smoking) and a 10-year risk of 10 percent or more, and selectively offering one at 7.5 to under 10 percent. It found the evidence insufficient to say whether starting a statin at 76 or older helps. The two documents differ in their numbers, which is one reason the decision is best made together with your doctor.

Muscle aches: what the evidence shows

Muscle pain is the side effect people fear most. In 2022, researchers pooled individual data from 19 double-blind trials with more than 120,000 people randomly assigned to a statin or a placebo. Muscle pain or weakness was reported by 27.1 percent of people on a statin and 26.6 percent on placebo. In the first year, the statin caused about 11 extra reports per 1,000 people, and the authors concluded that more than 90 percent of muscle symptoms reported by people taking a statin were not caused by the statin. After the first year there was no clear excess.

That does not mean aches are imagined. Muscles ache for many reasons, and some people really do react to a particular statin or dose. If you have new muscle pain, MedlinePlus advises telling your provider, who may check a blood test for muscle damage, and notes that pain may go away with a different statin. Options often include a lower dose, a different statin, or a different schedule. Serious muscle damage is rare.

Other side effects worth knowing

  • Blood sugar. Statins may raise the risk of type 2 diabetes, mainly in people who are already at high risk, such as those with prediabetes or obesity, according to MedlinePlus.
  • Liver tests. Statins can cause abnormal liver enzyme results, but actual liver damage is very rare.
  • Interactions. Grapefruit and grapefruit juice change how the liver breaks down some statins, and certain medicines and supplements interact as well. Review everything you take with your doctor or pharmacist.
  • Pregnancy. Statins are not taken during pregnancy or breastfeeding.

Questions to bring to your visit

What is my 10-year risk, and what would a statin change? Would a calcium score help us decide? What LDL goal makes sense for me? If I had side effects before, which options have we not tried? Food still matters alongside any medicine; our article on the Mediterranean diet is a good place to start. Do not stop a statin on your own without talking to your doctor. Chest pain, pressure, or sudden weakness or trouble speaking are reasons to call 911.

At Legacy Medical, Dr. Shtern can calculate your risk, review your full lipid results and talk through the tradeoffs at an unhurried pace. Our preventive care page explains the annual physical where this usually happens. If you would like to meet her first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.