My cholesterol levels are up. Do I need to take a statin?

High cholesterol levels can increase your risk for heart disease, the leading cause of death among adults in the United States. Heart disease and high cholesterol can also raise your likelihood of having a stroke.

If you have high cholesterol, the first step to protect your heart health is to focus on making healthy lifestyle changes, such as following a healthy diet, getting regular physical activitt, not smoking, and getting enough quality sleep. But depending on your age and individual risk factors for heart disease, your healthcare provider (HCP) may recommend cholesterol-lowering medication, such as a statin, to reduce your lifetime risk of heart disease, heart attack, and stroke.

What you should know about cholesterol

Cholesterol is not entirely harmful. It’s a waxy substance found naturally in our cells. It’s essential for many functions, such as hormone production and digestion. But like many things, too much—or an abundance of the “bad” kind—can build up in the arteries and increase the risk of heart attack and stroke.

There are two main types of cholesterol. Low-density lipoprotein (LDL) is the “bad” kind of cholesterol that can build up in your arteries. High-density lipoprotein (HDL) is the “good” kind that carries excess cholesterol to the liver, where it's removed from the body.

Your body makes all the cholesterol it needs for essential functions, so you don't have to worry about getting it in your diet. In fact, the cholesterol you get from food has little effect on the cholesterol in your blood. (Keep in mind, many high-cholesterol foods, such as red meat, full-fat cheese, and certain vegetable oils such as coconut oil and palm oil are also high in saturated fat, which has a much more significant impact on your cholesterol levels.)

Knowing your cholesterol numbers

A total cholesterol level of 240 mg/dL (milligrams per deciliter) or greater is considered high. But a “borderline” level between 200 to 239 mg/dL means you are at higher risk for heart disease, especially if you have other risk factors such as high blood pressure.

So, the rule of thumb is to keep your:

• Total cholesterol less than 200
• “Bad” LDL less than 130 (depending on your individual health history and risk factors, your LDL goal may be 70 mg/dL, or even 55 mg/dL)
• “Good” HDL (it absorbs cholesterol in the blood) more than 60
• Triglycerides less than 150

Who should be screened—and when

Cholesterol is checked by a blood test in your healthcare provider’s office. Generally, adults age 20 and older should have their cholesterol checked every four to six years, according to the American Heart Association. Those at higher risk for heart disease should have it checked more frequently. For example, children with a strong family history of heart disease or inherited high cholesterol may start screening as early as age 2. Talk to your HCP about what screening schedule is best for you.

Heart-healthy lifestyle changes

The first step in managing heart risks and keeping cholesterol levels within a healthy range is to make some healthy changes to your routine and daily habits, according to Rakesh Shah, MD, a cardiologist with Clear Lake Regional Medical Center in Webster, Texas. "Lifestyle modifications are the number one treatment for any medical problem, including high cholesterol," Dr. Shah says.

Your HCP will likely advise you to adopt a healthy diet and a regular exercise regimen. Specific strategies may include:

• Limiting saturated fat to 5 or 6 percent of your daily calorie intake
• Adopting the DASH diet, which is designed to lower high blood pressure, but benefits overall heart health, as well
• Increasing the amount of walking you do during the day—to work, at the office, during your lunch break, etc.
• If you smoke, they will encourage you to stop.

“Depending on your initial level of cholesterol, you may be able to lower your levels enough to avoid taking medication," Shah says.

When your HCP may prescribe a statin

If lifestyle changes alone are not enough to control your cholesterol levels, you may be eligible for a cholesterol-lowering medication, such as a statin. Research suggests that lowering cholesterol with statins can reduce the risk of stroke and heart attack. Statins do this by preventing additional plaque buildup in blood vessels and restoring function of the endothelium. The endothelium is the thin lining of the heart and blood vessels that helps control blood clotting and vessel relaxation and contraction.

Other cholesterol-lowering medications can be prescribed, but statins are often the drug of choice. "Statins have conclusively been shown to prevent heart attack and stroke," Shah says.

The goal for patients with a history of heart attack, stroke, or arterial disease in the legs is to reduce cholesterol by at least 50 percent using statin medication, according to Shah. "It doesn't matter what their initial cholesterol level is. We try to reduce them by half for the maximum benefit," he says.

Not everybody needs a statin, however. Your HCP will decide if you need a statin or other cholesterol-lowering medication based a range of variables and risk factors, such as your:

• Age
• Ethnicity
• Cholesterol level
• Blood pressure
• History of smoking
• History of medical conditions like kidney disease, psoriasis, HIV, premature menopause, gestational diabetes (diabetes during pregnancy) or preeclampsia
• Family history of heart disease
• Other individual risk factors for heart disease.

These and other factors will be used to determine your 10-year risk for heart disease. “You can be a person with cholesterol numbers that look normal, but if you have other risk factors, cholesterol becomes a factor to calculate your risk,” says Scott Joy, MD, Chief Medical Officer of the Continental Division of HCA Physician Service Group’s (PSG) Continental Division.

The 10-year risk is a calculation of your chance of developing heart disease—heart attack, stroke, peripheral artery disease and heart failure, among others—within the next 10 years. It takes cholesterol into account, but also age, blood pressure and treatment for high blood pressure, diabetes, and smoking.

For some people, their 30-year risk for heart disease should also be considered. Guidelines about the use of cholesterol-lowering drugs called statins were updated in March 2026 to protect younger patients who may be considered low risk for the next decade but face a high lifetime risk of cardiovascular events. So, if you are between 39 and 59 years old and have a low 10-year risk, your healthcare provider (HCP) will also calculate your 30-year risk to determine what treatment plan (if any) is best for you.

If additional information is needed, your HCP may order a heart CT scan called a coronary artery calcium (CAC) scan . Because calcium is a part of the plaque that builds up in your arteries, the CAC scan provides another measure to assess your overall risk for heart disease.

Statins may cause side effects

Statins are typically well-tolerated when taken to control high cholesterol. Adverse reactions are less common among people taking these drugs than with other cholesterol-lowering medications. But they're not entirely without side effects.

"Anywhere from 5 to 25 percent of patients will report side effects," Shah says. "The most common ones we encounter are muscle and joint discomfort," which can range from a dull soreness to excruciating pain.

You may also experience weakness that can make climbing stairs, rising from a seated position, and lifting your arms a challenge. The onset of symptoms usually happens within a few weeks or months of beginning statin therapy, but can occur at any time during treatment.

Don't hesitate to speak with your HCP about side effects that bother you or won't go away. Muscle pain is usually bearable but can be relieved by changing the dose or switching to a new type of statin.

Also talk to your HCP about side effects like fatigue, weakness, loss of appetite, or yellowing of the skin. These could signal liver problems. Allergic reactions can include swelling of the face, lips, tongue, and throat and difficulty breathing or swallowing, which may require immediate medical attention.

Other cholesterol-lowering medications

Despite the potential downsides, Shah believes statins are generally worth taking for certain patients. “When we prescribe statin medication, the benefit outweighs the risk of having side effects,” he says. “It's always good to follow your doctor's advice."

If statins are ineffective, or if the side effects are intolerable, your HCP may recommend a newer cholesterol-lowering drug, such as a PCSK9 inhibitor. It helps the liver remove more LDL cholesterol from the blood and limits the amount of plaque that can build up in the artery walls.

Another drug, ezetimibe, is also available and typically added to statin therapy when more LDL reduction is needed. It works by preventing the absorption of cholesterol in the intestine.

Bempedoic acid, which targets a specific liver enzyme and was approved by the U.S. Food and Drug Administration (FDA) in 2020, may also be an option, particularly for those who cannot tolerate statins. It works by reducing cholesterol production in the liver, causing liver cells to pull more LDL cholesterol out of the blood.

Your HCP is your best resource to help determine which medications are right for you.