4 Statin Side Effects You Shouldn’t Ignore—and How To Reverse Them Without Raising Your Cholesterol
Doctors explain why your 'bad' LDL cholesterol tends to creep up after age 50
They’ve been dubbed “wonder drugs” for their ability to torpedo LDL, or “bad” cholesterol, and slash the risk of heart disease and stroke. And while statin drugs broadly deserve such high praise, they can cause some pesky side effects in some patients—but they don’t have to. Keep reading for everything you need to know about the potential pitfalls of these drugs and simple strategies to mitigate or reverse them.
What are statins and how do they work?
“Statins are a group of medications that work by slowing cholesterol production in the liver,” explains preventive cardiologist Elizabeth Klodas, MD. “The two best-known types are Lipitor and Crestor—the generic versions are atorvastatin and rosuvastatin—and they’ve been around for about 40 years. They target a specific enzyme in the liver called HMG-CoA reductase that essentially tells the body, ‘Make LDL, make LDL, make LDL!’”
You probably know LDL by its more familiar nickname: “bad” cholesterol. While it can lead to a host of health problems, it doesn’t deserve such a black-and-white reputation. “Some of it is useful—our bodies rely on LDL to help make cell walls, hormones and bile acids. So it does have important roles,” notes Dr. Klodas.
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But the reality is that we can manufacture most of the LDL we need within our cells and don’t need large amounts circulating in the bloodstream. “When excess LDL is floating around, it looks for somewhere to ‘park,’ and that’s often the lining of our arteries,” reveals Dr. Klodas.
“That buildup leads to atherosclerosis, or hardening of the arteries that can cause dangerous blockages and can trigger sudden, potentially devastating events like heart attacks and strokes.” Hence, the need for statins. (Discover what’s considered normal cholesterol levels for your age.)
The benefits of statins: ‘It feels like taking a vitamin’
There’s a reason hundreds of millions of people take statins: They’re very effective. “They have truly changed the trajectory of heart-disease care and prevention,” says Dr. Klodas, dramatically reducing acute events like heart attacks and strokes.
“In fact, their impact is so significant, it’s becoming harder to show that additional interventions on top of good prevention strategies provide much extra benefit.”
Even procedures like angioplasty or bypass surgery, she observes, don’t always outperform simply placing patients on the right statin. That said, while they’re a remarkably powerful group of drugs, they’re not without their issues, acknowledges Dr. Klodas.
The 4 most common statin side effects—and why they happen
A whopping 90 to 95 percent of people experience no ill effects from taking statins. “It feels like taking a vitamin,” notes Dr. Klodas. “You take it once a day, morning or evening, and it doesn’t affect you at all—except that your blood tests improve.”
But that does leave 5 to 10 percent of people who suffer side effects. “Considering that there are now roughly 100 million Americans with high cholesterol, even a small percentage translates to a significant number of people who might have problems,” Dr. Klodas says.
Here, she reveals four potential side effects of statins. If you experience any of them, talk to your doctor about whether a different statin or dosage adjustment might be right for you:
Muscle aches
Soreness is the most common side effect people taking statins may have. “It tends to be symmetrical—and affect large muscle groups like shoulders, back and legs, or it can sometimes be felt more in the joints—elbows, knees, hip—rather than in, say, one finger,” says Dr. Klodas.
When people do experience muscle pain, it’s typically within the first six months of taking the medication. That means if you make it through the first year without any soreness, the chances of any issues developing later on are very low, she explains.
As for the severity of soreness, it varies widely. “Some people just notice that they take a little longer to recover from strenuous exercise, while others experience extreme aches and can barely get out of bed.”
Fortunately, most side effects, including muscle soreness, resolve when people are put on a different statin. In other words, just because you experience it with one form of the medication doesn’t mean you will with another, explains Dr. Klodas. “While all statins work through the same enzyme pathway, small differences in the chemical structure of the drugs can have a big impact on how you respond.”
Liver issues
The next potential side effect of statins includes liver function abnormalities, says Dr. Klodas. “HMG-CoA reductase—the enzyme statins target—lives in the liver. While these drugs are meant to affect just this one enzyme, in some people they can have a broader impact, showing up as elevated liver function tests.”
That’s why when starting patients on statins or adjusting their dosages, Dr. Klodas monitors liver function alongside cholesterol levels.
“It’s not unusual to see a small bump in liver enzymes at first as your body adjusts to the medication, but these typically return to normal on their own,” she explains. “The key concern is a consistent upward trend. Liver function changes are seen right away—not after years of use.”
In most cases, any abnormalities are completely reversible when the medication is stopped, she says. If liver function tests don’t return to normal, it’s likely unrelated to the statin and something else may be affecting the liver.
Cognitive changes
Brain fog and difficulty thinking are much less common, but Dr. Klodas has seen these side effects in her practice and has had to adjust patients’ statin medications in those cases. “People sometimes report feeling like something has changed—they’re not as sharp, their thinking feels cloudy or tasks that were once easy, like adding columns of numbers in their head, suddenly feel difficult.”
This may be because we’re all “fat heads,” adds Mark Menolascino, MD, internal medicine physician and author of Heart Solution for Women: A Proven Program to Prevent and Reverse Heart Disease.
“The brain is largely made of lipids and cholesterol, which could explain why statins may impact cognitive function,” he reveals. Again, these effects are typically reversible and may not be seen when patients switch to a different statin formulation.
Increased risk of type 2 diabetes
Statins are associated with an increased risk of type 2 diabetes over the long term, reveals Dr. Klodas. “This isn’t something that happens immediately—it develops gradually and has only been widely recognized in the last five to 10 years,” she explains.
Why this happens isn’t fully understood. Some of it may be because many people taking statins already have risk factors for type 2 diabetes—poor diet, lack of exercise or being overweight—which are also the reasons their cholesterol is high.
Even after accounting for these factors, however, there appears to be an independent, small increased risk of developing diabetes from statins. “Unlike other side effects, it’s unclear whether this is reversible,” Dr. Klodas points out.
Importantly, all four major statin-related risks are dose-dependent: higher doses increase the likelihood of side effects, she notes. That’s why it’s important to keep the statin dose as low as possible by maintaining healthy lifestyle habits, like eating a fiber-rich, plant-based diet and exercising regularly. (Discover more heart-healthy strategies.)
Why you may need statins in your 50s
Although our cells can make nearly all the cholesterol they need, they can also take in a lot of LDL circulating in the bloodstream. “It’s kind of like free money,” says Dr. Klodas. “Why waste energy making cholesterol when it’s already available? Taking in LDL requires specific receptors to grab the cholesterol and bring it inside our cells.”
But for women over 50, lower estrogen levels reduce LDL receptor activity, she explains. “As a result, the body’s ability to clear LDL slows down, and levels can rise even without changes in lifestyle.”
Indeed, many women notice their LDL increases even though their diet, exercise and weight haven’t changed. “I see this all the time in my practice,” Dr. Klodas observes. “Women show up with an LDL that’s suddenly 160—compared to 121 when they were younger—and their doctor wants to start statins. It’s very common.”
The bottom line on statins and LDL: ‘We can take control’
“While genetics play a role in our cholesterol levels, we can take control,” assures Dr. Klodas. “Lifestyle changes like diet, exercise and weight management can have a profound impact, sometimes as significant as taking a drug to reduce LDL.”
In fact, doing it through lifestyle is often better because it benefits more than just cholesterol; it improves many aspects of overall health.
“Plus, given that statins are lifelong medications and that side effects are dose-dependent, attending to lifestyle can reduce the amount of medication required to get your cholesterol levels to goal,” Dr. Klodas adds. That’s why she says a holistic approach not only supports your heart but can even minimize statin side effects. You can take charge of your health—and your cholesterol—starting today.
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