If you have high cholesterol, you would have heard of a cholesterol-lowering prescription drug called statins.

Statins are used to reduce “bad” cholesterol (low-density lipoprotein, or LDL). Too much of this waxy, fat-like substance in the blood can lead to plaque build-up in the walls of the arteries.

This plaque build-up narrows arteries, reduces blood flow to the heart or brain, and increases the risk of strokes and heart attacks.

Studies, including a meta-analysis of data from 26 randomised trials published in the renowned medical journal The Lancet in 2010, have proven that statin therapy reduces the risk of major vascular events by 25 per cent for 1mmol/L reduction in LDL cholesterol.

While some side effects in relation to statin use have been reported, these are rare.

Common myths

The use of statins is often misunderstood. Unproven claims about its side effects could be why it is underutilised among those at increased risk of heart attacks and strokes.

One common myth is that statin use leads to a range of side effects, such as muscle aches, liver and kidney damage, memory loss, and confusion.

But muscle aches are likely to be due to misattribution, resulting from a phenomenon known as the nocebo effect.

Researchers have found that patients on statins were more likely to think they were experiencing muscle-related side effects, while those who were unaware that they were on the medication reported no increase in such symptoms.

There is little evidence to prove that statins adversely affect the kidneys, memory, and cognition. On the contrary, results from randomised controlled trials suggest that statin therapy may slow down the progression of renal impairment. Studies have also found that statins may protect against dementia and cognitive changes, especially with long-term use.

While statin therapy may lead to a mild increase in liver enzymes, this can be managed by lowering the dose or changing to another brand.

Statins are associated with a small increase in risk of diabetes, mainly in those who are already at risk of diabetes. The benefits of reducing cardiovascular risk outweigh the slight increased risk of diabetes. Patients with diabetes benefit greatly from statins, which reduces their risk of heart attack, stroke, and death.

Supplements vs statins

There is currently no reliable evidence to prove that health supplements can safely prevent heart disease.

Unlike prescription medication, supplements generally do not undergo stringent clinical trials. In Singapore, they are not subject to approval and licensing by the Health Sciences Authority for importation, manufacture, and sale.

Even if supplements are marketed as “natural”, it does not necessarily mean they are safe for everyone. Some may even cause harm, depending on a person’s health and whether they are taken with other medication.

Patients with elevated risk of cardiovascular events will benefit from a high-intensity statin regime, even if their LDL cholesterol levels are average or below average.

Studies have shown that patients who took statins lowered their LDL cholesterol and reduced their overall risk of getting heart attack and stroke, regardless of their pre-existing cholesterol levels.

If you have concerns about statins use, it is advisable to seek your doctor’s opinion.

Adapted from an article “Clearing up myths on statins” in Murmurs, a publication of the National Heart Centre Singapore, and contributed by Dr Ho Jien Sze, Consultant from Department of Cardiology, National Heart Centre Singapore (NHCS).