Cholesterol — a fat-like waxy substance found in all cells — is necessary for the body to function.

But if you have too much cholesterol in your system, you can be at greater risk for heart disease and other vascular diseases. It can cause a buildup of plaque in the artery walls, which affects blood flow and can raise your risk for a heart attack.

Medications called statins can help to regulate cholesterol levels and may help address other health issues, too, although they’re not without risk.

Statins are a class of prescription drugs that help to lower cholesterol. They block the enzyme that the body uses to make cholesterol in the liver.

The liver, along with other cells in the body, makes about 75 percent of the body’s blood cholesterol. By blocking this enzyme, the amount of cholesterol your liver makes is significantly reduced.

Various types of statins are available. They all work similarly and offer the same level of effectiveness, but one might work better for you than another. Your doctor will prescribe a statin based on your cholesterol level and other risk factors for cardiovascular disease.

You may need to try two to three different statins before finding the one that’s the most effective for you.

Most statins successfully help lower low-density lipoproteins, also known as LDL or “bad” cholesterol. Lowering your cholesterol levels with statins helps decrease your risk of stroke, heart attack, and other vessel-related diseases.

“They work better than any other cholesterol treatment,” says Richard N. Fogoros, MD, a cardiologist and former professor of medicine.

Statins offer other benefits besides lowering your cholesterol. For example, they help stabilize the blood vessel lining, which benefits the whole body. This also makes plaque less likely to rupture in the heart, lowering the risk of a heart attack.

Statins also help to relax the blood vessels, which leads to a decrease in blood pressure.

The most common side effects of statins include nausea, vomiting, and aches and pains in the muscles and joints. You may also have constipation, gas, or diarrhea.

As your body adjusts to the medication, the side effects often go away.

Some more serious side effects include:

  • type 2 diabetes or higher blood sugar
  • confusion and memory loss
  • liver damage
  • muscle damage
  • kidney damage

Not everyone who takes a statin has side effects. According to the Mayo Clinic, you’re more likely to experience side effects if you:

  • are female
  • are 65 or older
  • have type 1 or 2 diabetes
  • take multiple medications to lower your cholesterol
  • have a smaller body frame
  • have liver or kidney disease
  • consume too much alcohol

If you’re experiencing side effects, your doctor may want you to try another statin or change your dose, or try a different medication.

Pros

  • reduces risk of narrowed arteries
  • helps fight inflammation, which can reduce artery damage

Statins help prevent cholesterol from forming in the liver. They may also help lower triglycerides and increase HDL levels.

Cons

  • dizziness
  • risk of liver damage and kidney failure when mixed with grapefruit

Most people are able to take statins without experiencing side effects, and the most common side effects of statins are mild. One is muscle pain, but that often goes away as the body adjusts to the drug. Another common side effect is feeling dizzy while on statins.

There’s also the possibility for negative reactions when mixing statins with grapefruit.

Mixing the two suppresses an important enzyme that normally helps the body process the medication. It balances out how much of it goes to the bloodstream. The compounds hinder the enzyme and create higher amounts of the drug in the bloodstream.

This means grapefruit can cause an increase to the side effects of the drug, which could put you at risk for muscle breakdown, liver damage, and kidney failure. More mild cases can cause painful joints and muscles.

In November 2018, the American Heart Association and the American College of Cardiology released new guidelines that identified groups who would benefit the most from statins.

These groups are at high risk of having a stroke or heart attack:

  • people who have cardiovascular disease
  • people with elevated LDL levels
  • people with type 2 diabetes who are between 40 and 75 years old
  • people who have a higher 10-year risk of heart attack

Taking statins is often (but not always) a lifelong commitment. Even if your cholesterol levels decrease, you may still need to take the medication. Otherwise, your levels will likely go back up once you’re off the meds.

However, if you change your lifestyle significantly, you may be able to go off the medication. This might include losing a significant amount of weight or radically changing your diet.

Regardless, never stop taking your meds without first speaking with your doctor.

There are other ways you can help decrease your cholesterol. Many of these involve lifestyle changes.

Dietary changes

Certain foods have been found to help lower cholesterol and the risk of vessel disease:

  • soluble fiber, found in oatmeal, prunes, apples, pears, kidney beans, and barley
  • fatty fish like herring, salmon, and halibut
  • nuts, like walnuts and almonds
  • olives, olive oil, and canola oils
  • foods fortified with plant-based substances called sterols, such as yogurt drinks, margarines, or orange juice
  • whole-grain, high-fiber, unprocessed grains

Quitting smoking

If you smoke, stopping can help improve your cholesterol levels, lower your blood pressure, and decrease your risk of a heart attack. The benefits of quitting smoking begin within hours, adds Dr. Fogoros.

Exercise

Losing excess weight — even 5 to 10 pounds — and regularly engaging in physical activity can help improve your cholesterol numbers.

Walk, bike, swim, or do anything to get your heart pumping. Talk with your doctor before starting a new fitness routine.

If you experience serious side effects or aren’t a statin candidate, your doctor may prescribe another type of medication to treat your cholesterol levels.

Cholesterol absorption inhibitor

The small intestine absorbs your diet’s cholesterol and releases it into the bloodstream. A cholesterol absorption inhibitor helps to limit this absorption of the cholesterol you consume.

Ezetimibe is one type of cholesterol absorption inhibitor.

PCSK9 inhibitors

A gene called proprotein convertase subtilisin/kexin type 9 (PCSK9) determines the number of low-density lipoprotein (LDL) receptors in the body. These receptors then regulate how much LDL cholesterol goes into your bloodstream.

PCSK9 drugs work by suppressing the PCSK9 enzyme expressed by the gene.

Bile acid sequestrant

The liver makes bile acids, needed for digestion, using cholesterol. Sequestrants bind to bile acids, making the liver use the extra cholesterol to produce more bile acids. That lowers the cholesterol in the blood.

Combination cholesterol absorption inhibitor and statin

This combination drug lowers the absorption of cholesterol in your small intestine and your liver’s cholesterol production.