Statins are one of the most common prescriptions in the United States with millions of adults using them to lower their cholesterol and risk of heart disease. Patients with heart disease risk factors, coronary disease, very high cholesterol levels, and/or diabetes may be prescribed statins to lower their chances of heart attack or stroke. Learn how statins work, their side effects and more about the four groups of people who benefit most from the drugs.
How statins work
The term cholesterol is used often when discussing your health status. Lowering cholesterol is a worthy goal, and statins help accomplish it…but how?
Our bodies make nearly 75% of our cholesterol with the other 25% coming from the foods we eat. High-density lipoprotein (HDL), or good cholesterol moves cholesterol to the liver for excretion. On the other hand, low-density lipoprotein (LDL), called “bad” cholesterol because it builds up in the arteries, can cause arterial narrowing and make it harder for blood to move through the body. Statins work to decrease the LDL cholesterol in your body and help your liver get rid of more cholesterol altogether.
The test used to measure your total cholesterol and help your doctor determine whether a statin is right for you is called a lipid panel and is typically ordered during a routine office visit. Although adults at low risk of heart disease may get a lipid panel only once every five years, your doctor may recommend more frequent tests depending on your age and if you have concerning cholesterol levels or other risk factors for heart disease, diabetes, stroke, etc. After you and your doctor receive your lipid panel results, you should have a discussion regarding the goals for your cholesterol levels and what changes you can make to achieve them.
Most people without coronary disease or major risk factors should aim to keep LDL levels under 100 mg/dL. For patients with significant risk factors or evidence of coronary disease, the goal is usually an LDL under 70mg/dL. Higher LDLs increase the likelihood of blocked arteries (coronary disease) that can lead to a heart attack or stroke. Statins have been proven to reduce the odds of having a heart attack or stroke by 20-30%.
Who do statins most benefit?
Doctors consider more than your LDL level to determine whether you should begin taking a statin. To determine if statins are best for you, many factors are considered, including your:
- risk of a heart attack or stroke
- family history of heart disease
- age
- weight
- health conditions (e.g., diabetes)
- fitness level
- diet
In fact, it could be other factors that best determine your suitability for a statin. The four main groups who may be helped by statins are:
- People who have one or more heart disease risk factors and are at risk of a heart attack
- People who have coronary disease
- People who have very high LDL cholesterol levels
- People who have diabetes
If you think statins might be a good fit for you, you should consult your health care provider.
Statins side effects are rare
Statins help millions to lower their cholesterol and avoid serious conditions. Like most medications, there are possible side effects and a potential lifetime commitment to the drug. However, it is generally acknowledged that the potential benefit of these drugs far outweighs the risk of side effects.
Most serious side effects are rare, and side effects that are most reported include headaches, nausea, achy muscles and joints, and a mild increase in sugar levels. These effects often go away once a patient’s body adjusts to the medication. As with any medication, when deciding whether to begin statins, you should consider your doctor’s recommendation and the drug’s potential benefits and drawbacks.
How the Health Plan Covers Cholesterol Tests and Statins
The Health Plan covers cholesterol screenings at 100% with no cost-sharing when administered for ACA preventive care by a network provider, assuming you meet the age, risk or frequency requirement for the service to be treated as ACA preventive care. In all other medically necessary circumstances, Health Plan rules apply, such as deductible and co-insurance.
Statins that are prescribed by your treating provider are covered under the Health Plan’s prescription drug benefit with the corresponding co-payment depending on whether the drug is generic or brand. To learn more, visit the March 2025 Health Plan Summary Plan Description and its updates.
