Managing Cholesterol: Statins vs. Diet and Exercise

Medically reviewed by Lindsay Slowiczek, PharmD on December 8, 2017Written by Elea Carey on July 7, 2015

Cholesterol overview

If you have high low-density lipoprotein (LDL), or “bad” cholesterol, you’re at risk for heart attack and stroke. Typically, we think of high cholesterol as having LDL levels above 160 mg/dL.

Our bodies need cholesterol. It’s in every cell and helps us produce hormones and process vitamin D. However, not every form of cholesterol is good for you.

Aim for total cholesterol levels below 200 mg/dL. Your LDL should be below 100 mg/dL, but may be higher or lower based on your individual cardiovascular disease risk factors. Your high-density lipoprotein (HDL), or “good” cholesterol, should be above 60 mg/dL.

What are statins?

Statins are a class of prescription medication recommended for people who have high LDL cholesterol. They work by altering how your liver produces cholesterol. Lower production means less LDL cholesterol levels throughout the body. One large study suggests that statins work best for people whose cholesterol problem is inherited.

How exercise can help

The American Heart Association strongly advises lifestyle changes, including diet and exercise, to lower heart attack risk. According to the Cleveland Clinic, exercise reduces triglycerides, raises HDL, and has a small lowering effect on LDL.

Do statins have side effects?

According to a 2017 study, around 39 million American adults age 40 and above take statins. And while for many there are no side effects at all, some people do experience them. Side effects can include muscle aches, liver and digestive problems, and higher blood sugar levels, which could lead to type 2 diabetes. Memory problems have also been reported. However, a direct cause-and-effect association hasn’t been determined.

According to the Mayo Clinic, the following groups may be at greater risk of experiencing side effects:

  • women
  • people over 65
  • those who drink heavy amounts of alcohol (more than a drink a day for women and more than two a day for men)

Does exercise have side effects?

Of course, exercise doesn’t have any side effects.

If you’ve got heart problems, start exercising slowly and stop immediately if you have chest pains or difficulty breathing. If you’re planning on starting vigorous exercise or if you have a history of heart disease, ask your doctor about doing a stress test prior to starting exercise.

Other than that, moving around outside or in a workout room for 20 to 30 minutes a day, five days a week is very likely to make you feel better inside and out.

Similarly, changing to a heart-healthy diet shouldn’t have side effects, as long as you’re getting enough calories.

Exercise and healthy eating have lots of benefits beyond heart health that you probably already know about, like helping you lose weight and improving your mood.

Which wins out?

Statins have beneficial side effects as well. Research conducted at the University of Naples found that statins may have a positive effect on telomeres. These are the pieces at the end of DNA that shorten as you age. This suggests that statins could help slow the aging process, but this needs more study.

“The beneficial effects of statin drugs extend beyond the measured level of total cholesterol and other lipids such as triglycerides,” says Robert F. DeBusk, MD, professor emeritus of cardiovascular medicine at Stanford University. “The statin drugs markedly reduce LDL and triglycerides, while increasing levels of HDL or ‘good’ cholesterol.”

By comparison, DeBusk says, “The role of exercise in lowering cardiovascular risk is less well-established than the role of lipid-lowering drugs, and the effects of diet are more modest.”

Robert S. Greenfield, MD, medical director of noninvasive cardiology and cardiac rehabilitation at MemorialCare Health System, agrees that statins reduce cholesterol more than lifestyle changes. “Diet and weight loss can lower total cholesterol between 10 and 20 percent. But the most potent statins at their highest doses can lower cholesterol by 50 percent,” he says.

The takeaway

Both doctors highly recommend a heart-healthy diet and regular exercise, even if you do take statins. “Patients who are significantly overweight, or eating too much saturated and trans fats, can lower their cholesterol significantly by eating a Mediterranean diet with caloric restriction and exercise,” says Greenfield.

If you choose not to take statins, what other prescription options are there? Early cholesterol medications like bile acid sequestrants, nicotinic acid, and fibric acids also affect the liver. While they’re still available, they’re in very limited use.

“Individuals with clinical features of heart disease or a history of heart attack or stroke may benefit substantially by treatment with aspirin,” says DeBusk.

The bottom line?

Almost anyone can improve their heart health and reduce their stroke risk with simple lifestyle changes, like a low-fat diet and moderate exercise. If those activities don’t bring down cholesterol enough — or if you want to make certain you’re doing everything you can to lower your heart disease and stroke risk — statins are a viable option for most people.

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