Statins: types, uses, side effects and alternatives

Statins are the world's most prescribed cholesterol drugs, and for good reason: by lowering LDL - the bad cholesterol - they reliably reduce heart attacks, strokes and deaths in people at elevated risk. Guidelines recommend them for anyone with existing cardiovascular disease and for many people with diabetes, high LDL or a high calculated risk.

The class ranges from older, milder agents to potent ones. Atorvastatin and rosuvastatin can cut LDL by half or more; simvastatin and pravastatin are moderate; fluvastatin and lovastatin are gentler. The choice depends on how much lowering is needed and what else you take.

Most people take statins without trouble. The commonest complaint is muscle aches, reported by a small minority; a slightly raised blood sugar and, rarely, liver-enzyme changes also occur. Serious muscle injury is very rare. Side effects often resolve by switching statin, lowering the dose, or dosing every other day - so report problems rather than silently stopping.

When a statin genuinely cannot be tolerated, alternatives exist: ezetimibe lowers LDL modestly and combines well with a low-dose statin; newer injectable agents lower it dramatically for high-risk patients; and bempedoic acid avoids muscle symptoms.

Whatever the drug, diet, exercise, weight control and not smoking remain the foundation of cholesterol care.