For nearly four decades, statins have been among the most studied and widely prescribed cholesterol-lowering medications in the United States. Clinical trials have shown that statins reduce LDL cholesterol and lower the risk of major cardiovascular events, including heart attacks and strokes, particularly among patients at elevated cardiovascular risk who meet criteria for treatment.
Despite decades of evidence supporting their use, some patients remain hesitant to take statins because of concerns about muscle pain, weakness, and other possible side effects.
Research is examining why some people experience muscle-related symptoms while taking statins. Researchers at McMaster University recently identified a possible biological pathway involving immune activation and muscle response that may help explain why certain patients experience symptoms. However, the findings are still being studied and do not change current prescribing recommendations.
Current cardiovascular guidelines continue to recommend statins as a first-line therapy for many patients who need LDL cholesterol reduction because of their extensive evidence base and demonstrated cardiovascular benefits.
Why Doctors Prescribe Statins
Statins work by blocking an enzyme in the liver called HMG-CoA reductase, which plays a role in cholesterol production. By reducing the amount of cholesterol made by the liver, statins lower levels of low-density lipoprotein cholesterol (LDL-C), often called “bad cholesterol.”
According to the American Heart Association, high LDL cholesterol contributes to plaque buildup in arteries, increasing the risk of heart attack and stroke.
Doctors typically prescribe statins for patients who have:
- A history of heart attack, stroke, or other cardiovascular disease;
- Very high LDL cholesterol levels;
- Diabetes with elevated cardiovascular risk;
- A calculated risk of developing cardiovascular disease over time.
The American College of Cardiology and American Heart Association cholesterol guidelines recommend evaluating a patient’s overall cardiovascular risk — not cholesterol numbers alone — when deciding whether statin therapy is appropriate.
How Many Americans Take Statins?
Statins remain among the most commonly used prescription medications in the United States.
Approximately 27–28 million U.S. adults are currently taking a statin. A July 2026 analysis published in JAMA using National Health and Nutrition Examination Survey (NHANES) data from 2017–2023 found that 17.8% of non-pregnant adults aged 30–79 without known atherosclerotic cardiovascular disease reported current statin use, corresponding to about 27.6 million people in that primary-prevention population.
When adults with existing cardiovascular disease are also included, broader estimates place the total number of Americans on statins in the 30–40 million range.
Data from the Centers for Disease Control and Prevention show that statins have historically accounted for the vast majority of cholesterol-lowering medication use in the United States. In CDC data collected from 2011–2012, the most recent CDC analysis specifically measuring cholesterol medication classes found that approximately 93% of adults taking cholesterol-lowering medication reported using a statin.
While newer cholesterol-lowering medications have expanded treatment options, statins remain the most commonly used first-line cholesterol medication because of their long track record of reducing cardiovascular risk.
A separate analysis published through the National Library of Medicine estimated that tens of millions of American adults meet guideline criteria for statin therapy, although actual use remains lower than the number recommended for treatment.
Why Are Some Patients Afraid to Take Statins?
Despite strong evidence supporting their effectiveness, some patients remain hesitant to take statins because of concerns about possible side effects.
The most common concern is muscle pain.
Patients frequently report:
- Muscle aches;
- Weakness;
- Cramping;
- Fatigue during exercise.
However, researchers have found that determining whether symptoms are caused by statins can be complicated.
A review from the National Lipid Association notes that statin-associated muscle symptoms are among the most commonly reported concerns, but the symptoms can vary widely and may overlap with other conditions or normal muscle discomfort.
A large analysis published in The Lancet examining more than 150,000 participants from randomized trials found that statin therapy was associated with a small increase in muscle symptoms during the first year of treatment, but most reported muscle symptoms were not caused by the medication itself. The researchers concluded that the cardiovascular benefits of statins generally outweigh the small risk of muscle-related side effects for patients who meet treatment criteria.
New Research Looks at Why Muscle Symptoms Happen
Researchers at McMaster University are investigating biological mechanisms that may help explain why some patients experience muscle symptoms while taking statins.
The research identified a possible connection between statin-related metabolic changes in muscle cells and an immune response that may contribute to symptoms such as muscle pain or weakness in certain individuals. Scientists said the findings could eventually help identify patients who are more likely to experience side effects or develop strategies to reduce those effects.
The research remains preliminary, and current medical guidance has not changed. Patients experiencing possible side effects are advised to discuss symptoms with their healthcare provider rather than stopping medication without medical guidance.
Are Some Statin Brands More Likely to Cause Side Effects?
There is no medical consensus that one statin brand is universally the “worst” for side effects.
Common statins include:
- Atorvastatin (brand name Lipitor);
- Rosuvastatin (brand name Crestor);
- Simvastatin (brand name Zocor);
- Pravastatin (brand name Pravachol);
- Lovastatin (brand name Mevacor).
Although these medications work through the same general pathway, they differ in potency, metabolism, and how long they remain active in the body.
The likelihood of side effects can depend on:
- Dose strength;
- Drug interactions;
- Age;
- Kidney or liver function;
- Genetics;
- Other medications being taken.
Some studies suggest the risk of muscle symptoms may vary depending on factors such as statin dose, medication interactions, and individual patient characteristics. However, there is no definitive ranking showing that one statin is universally more likely than another to cause side effects. The FDA notes that serious muscle injury, including rhabdomyolysis, is rare.
How Long Have Statins Been Around?
The first statin, lovastatin, was approved by the FDA in 1987.
Since then, statins have become one of the most studied classes of medications in medicine.
Large clinical trials have repeatedly shown cardiovascular benefits, including:
- The Scandinavian Simvastatin Survival Study (4S), which demonstrated reduced mortality among patients with coronary heart disease;
- The JUPITER trial, which found benefits in certain patients with elevated cardiovascular risk despite normal LDL levels.
What Alternatives Exist If Someone Cannot Take Statins?
For patients who cannot tolerate statins or need additional cholesterol lowering, physicians have several alternatives. In many cases, these medications are used alongside statins rather than as replacements, particularly for patients who need additional LDL reduction.
Ezetimibe
Ezetimibe reduces cholesterol absorption in the intestine.
The IMPROVE-IT trial found that adding ezetimibe to statin therapy modestly reduced cardiovascular events in certain high-risk patients compared with statin therapy alone.
PCSK9 Inhibitors
Medications such as evolocumab and alirocumab can significantly reduce LDL cholesterol by increasing the liver’s ability to remove LDL from the bloodstream.
The FOURIER trial found that adding the PCSK9 inhibitor evolocumab to statin therapy reduced cardiovascular events in patients with established cardiovascular disease.
Bempedoic Acid
Bempedoic acid is another cholesterol-lowering medication option, particularly studied in patients who cannot tolerate statins.
The CLEAR Outcomes trial found that bempedoic acid reduced major cardiovascular events among statin-intolerant patients.
Are Alternatives as Effective as Statins?
The answer depends on the patient and the medication.
Statins remain the most widely recommended first-line treatment because they have decades of evidence showing reductions in heart attacks, strokes, and cardiovascular deaths.
Some newer medications can provide significant LDL reductions and cardiovascular benefits, but many are primarily used:
- When statins are not tolerated;
- When cholesterol goals are not reached with statins alone;
- For patients at very high cardiovascular risk.
Updated 2026 cholesterol management guidelines from the American Heart Association and American College of Cardiology continue to emphasize personalized cardiovascular risk assessment, LDL cholesterol reduction, lifestyle changes, and shared decision-making between patients and clinicians. The guidelines also incorporate newer risk assessment tools and continue to identify LDL-lowering therapy, including statins when appropriate, as a key component of cardiovascular disease prevention.
The Bottom Line for Patients
Statins remain one of the most studied and effective tools for preventing cardiovascular disease, but researchers continue investigating why some patients experience side effects.
For patients experiencing muscle pain or other concerns, doctors may adjust dosage, switch medications, or consider alternatives rather than abandoning cholesterol treatment altogether.
Medical experts recommend patients discuss concerns with their healthcare provider before stopping a statin, because the decision depends on personal risk factors, cholesterol levels, and medical history.
Provided by Dallas Express
