The First Steps With Statins
Statins: the few things that matter most, and the mistakes that catch people out early.
Medicines that lower LDL cholesterol by inhibiting its production in the liver.
Key takeaways
- Mechanism: inhibit HMG-CoA reductase in the liver
- Common starting dose, primary prevention: atorvastatin 20mg
- Most useful single change: Discuss a different statin or a lower dose before stopping altogether.
- Commonest mistake: Stopping because of aches without speaking to your GP.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Why bother
They are among the most studied medicines in use and among the most stopped, usually over muscle aches that blinded trials attribute largely to expectation.
Start here
Begin here, with two things rather than ten.
- Discuss a different statin or a lower dose before stopping altogether
- Take it at the time of day you will actually remember
Then add these
Once the first two are automatic, these are worth adding.
- Keep taking it long term; the benefit accrues over years
- Report muscle symptoms rather than stopping silently
The numbers, in one place
| Measure | Figure |
|---|---|
| Mechanism | inhibit HMG-CoA reductase in the liver |
| Common starting dose, primary prevention | atorvastatin 20mg |
| NICE risk threshold to offer | 10 per cent ten-year risk |
| Most reported side effect | muscle aches |
| Monitoring | liver function before starting and within the first year |
Common early mistakes
- Stopping because of aches without speaking to your GP
- Grapefruit juice with some statins
- Continuing in pregnancy or while trying to conceive
Where to go next
- What Statins Is, and Why It Matters
- A Working Checklist for Statins
- Statins — the reference entry
- Blood Pressure: What the Evidence Actually Says
- Cholesterol: Sorting the Evidence From the Noise
When to speak to a doctor
Contact a doctor urgently for severe, widespread muscle pain or weakness, especially with dark brown urine, which can indicate rhabdomyolysis. Also seek advice for yellowing of the skin or eyes, or unusual tiredness with loss of appetite. Stop before conceiving and during pregnancy.
Where this comes from
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
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