Understanding statins: A comprehensive overview

Written by: Dr Gosia Wamil
Edited by: Kate Forristal

In her latest online article, Dr Gosia Wamil gives us her insights into statins. She talks about current guidelines on statins, how high someone’s cholesterol should be to take statins, how long statins take to work, if the effects wear off, long term risks, safety concerns and if there’s any evidence-based alternatives to statins.


What are the current guidelines on who should be prescribed statins? How high should someone’s cholesterol levels be to take statins?

Statins are primarily prescribed for individuals at an increased risk of cardiovascular disease based on various factors, not solely cholesterol levels. Factors considered include age, family history of heart disease, smoking status, blood pressure level, diabetes, and cholesterol levels. The decision to prescribe statins is often guided by overall cardiovascular risk assessment tools like the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator (in the UK QRISK3 but there are also newer calculators based on AI analysis of electronic healthcare records which offer more accurate assessment of cardiovascular risk and can improve prediction who really need to be treated). 

The National Institute for Health and Care Excellence (NICE) in the United Kingdom provides guidelines for using statins to prevent cardiovascular disease in people who have never had a significant event (Primary Prevention- preventing the first occurrence) of cardiovascular disease, for adults aged 40 to 75 years with a 10% or greater 10-year risk of developing CVD (based on QRISK3). For secondary prevention (preventing recurrence of heart attacks and strokes), NICE recommends offering high-intensity statin therapy to adults with a heart attack or stroke or who have established atherosclerotic CVD.

NICE does not specify a particular cholesterol threshold for initiating statin therapy but emphasises using the QRISK3 tool to assess overall cardiovascular risk.


How long do statins take to work? Do the effects wear off after many years on the drugs?

Statins typically reduce low-density lipoprotein (LDL) cholesterol levels within a few weeks of initiation. However, achieving the complete efficacy of statins may necessitate several months for stabilisation. Importantly, the enduring efficacy of statins in mitigating cholesterol levels and diminishing the propensity for cardiovascular events is evidenced, with no indication of waning effectiveness observed even after prolonged use over many years, provided that they are consistently and appropriately administered.


LDL should be monitored, and the statin dose may need to be adjusted occasionally to achieve a good effect. 


What do we know about some of the long-term risk/reward trade-offs when it comes to taking statins for many years or even decades? Are there any safety concerns about long-term use?

Long-term statin use is considered safe and associated with significant benefits in reducing cardiovascular events. Statins are most effective if started very early, before the onset of heart disease, and they should be taken life-long to offer full protection. Some concerns about long-term use include potential muscle-related side effects (myopathy) and, rarely, liver enzyme elevation. Regular monitoring and reporting of any unusual symptoms to a healthcare provider are essential. A recent large meta-analysis from Oxford University showed that muscle pain, the most frequently reported side effect of statin, is wrongly attributed to statins in 90% of patients taking them.  


The benefits of long-term statin use in preventing heart attacks, strokes, and mortality often outweigh potential risks, especially for individuals at high risk of CVD.


Are there any known evidence-based alternatives to statins, particularly for those concerned about the side effect profile?

Given the highly favorable safety profile of statins they remain to be a cornerstone of clinical guidelines worldwide. Concerns regarding potential side effects or challenges with tolerance may prompt the exploration of alternative strategies. Lifestyle adjustments encompassing dietary modifications, regular exercise, and smoking cessation represent viable options. Additionally, alternative cholesterol-lowering medications, such as ezetimibe (usually prescribed as additive therapy in patients who have high cholesterol on statins or PCSK9 inhibitors, or a strategic amalgamation of these approaches may be considered.


PCSK9 inhibitors have gained popularity for effectively reducing LDL-C by around 50-60% or more, especially for those with high LDL-C levels or at a high risk of cardiovascular disease or those who have established heart disease. They are often used in addition to statins or for those who can't tolerate statins. Advantages include potent LDL-C reduction and being well-tolerated, though they come as injections and can be costly. Whether they are better than statins depend on an individual's specific health circumstances and considerations such as cost and administration preferences. The choice of treatment should be made in consultation with a healthcare provider.



Dr Gosia Wamil is an esteemed cardiologist with over 20 years of experience. You can schedule an appointment with Dr Wamil on her Top Doctors profile.

By Dr Gosia Wamil

Dr Malgorzata (Gosia) Wamil, PhD is an Oxford-trained, internationally recognised consultant cardiologist. She practices at the world-renowned Mayo Clinic Healthcare in London and the Manor Hospital in Oxford. Her clinical specialities are heart failure and the precise application of non-invasive cardiac imaging techniques, including cardiovascular MRIcardiac CT, and advanced echocardiography (trans-oesophageal echocardiography, bubble echocardiography, contrast echocardiography, 3D echocardiography, and stress echo).
Dr Wamil’s extensive expertise has been honed through years of dedicated practice and specialized training, with patients frequently asking her for a second opinion. Dr Wamil pursued comprehensive cardiology training at the Oxford University Hospitals between 2008 and 2017. This rigorous program encompassed fellowships in cardiovascular medicine, advanced cardiac imaging, heart failure and cardiomyopathies. During this period, Dr. Wamil earned internationally recognised accreditations in echocardiography, cardiac CT, and cardiac magnetic resonance, showcasing her commitment to excellence. She has received multiple awards for her academic excellence, including fellowships and grants from esteemed organizations like the British Heart Foundation, the European Association of Cardiovascular Imaging and the European Society of Cardiology.
Acknowledged for her academic excellence, Dr. Wamil has been honoured with multiple awards, fellowships, and grants from esteemed organizations such as the British Heart Foundation, the European Association of Cardiovascular Imaging, and the European Society of Cardiology. Her research journey spans the spectrum, from fundamental science and drug development (MSc and PhD in Cardiovascular Science, University of Edinburgh 2005-2008), to pioneering proof-of-concept studies employing imaging techniques (British Heart Foundation Postdoctoral Fellowship at the University of Oxford 2016-2017) and randomized clinical trials (MSc in Clinical Trials, University of Oxford 2022-2024).

Dr. Wamil is known for her cardiac MRI, CT, and advanced echocardiography expertise and is often able to combine them in ways that are transformational in the treatment of complex cardiovascular cases. Actively participating in the European Association of Cardiovascular Imaging, she holds a distinguished role as a member of the prestigious Leaders of Tomorrow Programme. This involvement allows her to be pivotal in organizing international teaching courses and setting standards for operating cardiac imaging departments across Europe. Her dedication to education extends to imparting knowledge and expertise to aspiring medical students and junior doctors through diverse teaching platforms and programs. 
In her clinical practice, Dr. Wamil excels with a uniquely effective human-centric and holistic approach to medicine with patients. Her expertise, however, extends well beyond the hands-on practice.
She holds the esteemed position of Honorary Senior Researcher Fellow in the Deep Medicine Department at the University of Oxford, actively contributing to ground-breaking research. As a Diabetes Pharma Committee Member at the National Institute for Health and Care Excellence (NICE), she co-authored national guidelines for managing heart disease in people with diabetes. In recognition of Dr. Wamil's scientific contribution, she holds the title of Fellow of the European Society of Cardiology and is a member of several medical organisations such as the Royal College of Physicians, British Society of Echocardiography, and European Society of Cardiovascular Imaging and the European Heart Association.

View Profile

Overall assessment of their patients

  • Related procedures
  • Heart attack
    Hypertension (high blood pressure)
    Heart failure
    Injury valves
    Heart murmur
    Ambulatory electrocardiogram (Holter)
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.