Should you take statins?
If you’re over 40 and your LDL cholesterol is above 100 mg/dL, it’s time to talk with your cardiologist about statins. High LDL signals a higher risk of heart disease, a major cause of death as we age. Statins, medications that lower cholesterol, are one of the most effective ways to reduce this risk. Despite online criticism, including from a few cardiologists, the evidence for statins is strong. This article explains the case for statins while addressing concerns and alternatives.
Rather than focusing only on LDL or VLDL, a better measure of heart disease risk is apolipoprotein B (ApoB). This protein carries harmful cholesterol through your blood, contributing to plaque buildup in arteries, and it’s easy to measure directly. It should be less than 90, and lower is better.
Statins are an important tool in lowering ApoB — which you want to get as low as possible. A low dose of statins can give you most of the benefit with probably no side effects. For example, after I had a stroke, my doctor raised my prescription to 40 mg Atorvastatin, which is standard after a stroke. After about a year, I asked to go back down to 20 and he said sure, that would be fine, so I did. Ask your doctor about starting with the smallest dose he/she recommends.
In my view, statins are just a part of your journey to better heart health. You can lower ApoB more reducing inflammation and insulin resistance than you can by taking statins. If you’re really serious about controlling ApoB, your A1c should dictate what you eat. If your A1c is 3.8 or greater, you should eat no carbs and be in ketosis. If you can get it down under 5.6, then you can add carbs in, but carefully. And you can do exercise — especially hard exercise — to keep your arteries soft and reduce plaque. Managing stress matters too. All these things combine to help reduce your risk of heart disease.
Online, you’ll find plenty of anti-statin arguments, sometimes from cardiologists, warning about muscle pain, liver problems, or claiming cholesterol isn’t the main issue. These points deserve consideration—side effects like muscle pain are real for a small group. But large-scale meta-studies, the most reliable form of medical evidence, consistently show that statins significantly cut heart attack and stroke risk for most people over 40 with high ApoB or other risk factors.
The meta-studies
Meta-studies look at many large-scale trials, throw out those that are poorly designed or underpowered, and try to summarize the total evidence found across the good ones, which are usually randomized, placebo-controlled (RCT). Metastudies must be taken seriously and can’t be ignored. They offer the strongest evidence on statins’ role in reducing cardiovascular risk. Below is a compact summary of major findings, focusing on adults over 40 with risk factors like high apolipoprotein B (ApoB).
Cholesterol Treatment Trialists’ Collaboration (2010, 2015)
Scope: 26 RCTs, >170,000 participants, primary and secondary prevention.
Findings: Statins cut major cardiovascular events (heart attacks, strokes, deaths) by 20-25% per 1 mmol/L LDL reduction. Benefits consistent for those over 40, with or without prior heart disease. Low-dose statins effective, side effects rare (<1% myopathy).
Cochrane Review (2013)
Scope: 18 RCTs, >56,000 participants, primary prevention.
Findings: Statins reduced all-cause mortality by 14% and cardiovascular events by 25% in people over 40 with risk factors. Side effects minimal.
Baigent et al. (2016)
Scope: 28 RCTs, >180,000 participants, broader populations.
Findings: Statins lowered heart attack and stroke risk by 24% per 1 mmol/L LDL drop, effective across ages and risk levels. Benefits outweigh risks (e.g., slight diabetes increase in 0.1%).
No major meta-study concludes that statins should generally not be used by the general population over 40 with cardiovascular risk factors, such as high apolipoprotein B (ApoB) or LDL cholesterol above 130 mg/dL. The most comprehensive meta-analyses, like those from the Cholesterol Treatment Trialists’ Collaboration (CTT, 2010, 2015) and the Cochrane Review (2013), consistently show statins reduce cardiovascular events (heart attacks, strokes) and mortality by 20-25% per 1 mmol/L LDL reduction in adults over 40, with benefits outweighing risks for most, even at low doses. People who argue against statin use cite smaller studies with less statistical power, and they often offer “remedies” with almost no high-quality studies behind them. Statins lengthen lives for those who tolerate them.
Other factors
One aspect of heart disease is genetic. Some people have the LP(a) gene, which precludes them to having high cholesterol and heart disease. These people should be doing everything they can to lower cholesterol, with the general approach being statins, diet, and exercise.
For the roughly 5% of people who can’t tolerate statins due to side effects like muscle aches, there are alternatives. Medications like colesevelam, ezetimibe, red-rice yeast, or PCSK9 inhibitors (expensive) can also lower ApoB or reduce cardiovascular risk through other mechanisms, such as decreasing inflammation. Your doctor can design a treatment plan tailored to your needs.
Summary
If your LDL is high, you should take action to improve your health. Statins, especially at low doses, are backed by decades of research showing they extend life. Combine them with lifestyle changes, and you’re building a strong foundation. Don’t let online debates steer you off course. Get your ApoB tested, have an honest conversation with your cardiologist, and find the plan that’s right for you. Use your brain, not your heart, to decide what’s best for your heart.
If you’re over 50, there’s much more on this website for you to learn about health and longevity. A good place to go next would be my facts page, or if you’re interested in supplements, check out my stack page. You should also see my store.
Finally, here’s Dr Peter Attia talking about statins …