A common patient question, the answer may shock you- TRUTH about STATINs
I’ve had so many patients ask about this medication, some have been started on it without fully understanding why, others have remained on it long-term without follow-up, and the most concerning cases involve patients well beyond the age limit supported by available data.
Statins provide the greatest benefit for people with existing heart disease, offering a 3–5% absolute risk reduction, while for those without heart disease, the benefit is much smaller, less than 1%. Although widely prescribed, statins do not reduce coronary calcium scores, carry risks like muscle pain, new-onset diabetes, and offer limited value in low-risk individuals.
Let me explain the difference of Absolute vs. Relative Risk Reduction
Why It Matters:
When a study reports a 30% reduction in heart attacks, that's a Relative Risk Reduction (RRR), it tells you how much the risk dropped proportionally compared to the control group. But what's often more meaningful is the Absolute Risk Reduction (ARR), the actual percentage-point drop in total risk.
Example:
Out of 1,000 people, if 10 in the placebo group have a heart attack and 7 in the treatment group do:
ARR = 1% (10 - 7 per 100 people)
RRR = 30% (proportional drop)
RRR can sound dramatic, but the real-world impact (ARR) is often modest. Keep this in mind as you continue to read below.
U.S. Burden: Heart Disease Costs Skyrocket
Heart disease remains the leading cause of death in the U.S., and spending continues to climb; even though overall incidence has plateaued. In 2020, individuals with coronary disease incurred $13,000 more annually than those without. National expenditures for cardiovascular disease rose from $212 billion in 1996 to $320 billion by 2016 . Separately, statins alone accounted for $16.9 billion in prescriptions (2012–13) .
What Statins Do and Don’t
Statins block the enzyme HMG‑CoA reductase in the liver, lowering LDL cholesterol and reducing inflammation. However, using CT scans to track arterial calcium (CAC scores) shows statins don’t reduce calcium buildup; in many cases, calcium scores actually rise. And we use CT scans as the major way to evaluate cardiac risk.
Let me remind you that LDL is not the entire picture. It's just a piece.
Key Statin Trials and Their ARRs
JUPITER (Rosuvastatin; primary prevention)
Enrolled ~17,800 healthy people with low LDL but high CRP
RRR: ~44% drop in major events; ARR: ~1.2% over ~1.9 years; about 1.6% on treatment vs. 2.8% on placebo
NNT: 95 over 2 years; 25 over 5 years for composite outcomes
All-cause mortality ARR: ~0.6% (500 people treated for one year to prevent one death)- This is not very good!
WOSCOPS (Pravastatin; primary prevention in men)
~6,600 men followed for nearly 5 years
RRR: 31% fewer CHD events.( not heart attacks)
ARR: ~1–2%, with ~5% ARR in secondary prevention
NEJM Rosuvastatin Trial (intermediate-risk without CVD)
12,705 participants
Two-year ARR: primary endpoint dropped from 4.8% to 3.7% (ARR 1.1%, NNT 91)- Again not very good!
Who Benefits Most?
Secondary prevention patients (existing disease) see larger ARR; around 5%
Primary prevention (no existing disease): ARR is small (~0.5–1%), with risk closely tied to plaque presence
For those with CAC score = 0, JUPITER showed no benefit over ~10 years
Data on older adults (75+) is limited and minorities
Side Effects & Downsides
Muscle pain: ~3% in trials, up to 10–15% in clinical practice
New-onset diabetes: JUPITER showed ~25–28% increased risk; with diabetes risk, statins avoided 134 events at cost of 54 new diabetes cases; in lower-risk people, no diabetes risk
Liver enzyme elevations, neuropathy, and sexual side effects are less common but reported
Interpreting the Evidence
For people with existing heart disease, statins demonstrably reduce mortality (ARR ~5%).
For primary prevention, ARR is small (often <1%), and benefits must justify lifelong medication
Meta-analyses show modest declines in all-cause mortality and heart events, only in higher-risk groups
I hope this helps anyone confused about data on Statins and my stand point of making a personalized decision of using such a drug.
Best,
Dr. Hutson
Meet the Author
Dr. Lauren Hutson is an experienced Primary Care Provider with degrees in Neuroscience and Biology from University of Texas at Austin. She completed her residency at Baylor Scott and White, Texas A&M, and has a strong focus on preventive care and chronic illness management. During the pandemic, she provided critical care as a Hospitalist in New Mexico, exemplifying her commitment to holistic, patient-centered care.
