Few questions come up more often in my consultations than this one: “Do I actually need to be on a statin?” It’s a fair question, and the honest answer is more nuanced than either side of the internet will tell you. As a board-certified cardiologist and electrophysiologist, I don’t belong to the “statins are poison” camp or the “everyone over 50 should take one” camp. The truth lives in between, and it depends on you.
What statins actually do — and where they genuinely help
Statins lower LDL cholesterol and, just as importantly, calm inflammation in the artery wall. For people who have already had a heart attack, a stent, or a stroke — what we call secondary prevention — the evidence is strong and I recommend them readily. The risk is high, and the benefit is real.
The picture gets murkier in primary prevention: otherwise healthy people with no established heart disease. Here the absolute benefit for a low-risk person can be quite small, while the conversation about side effects — muscle aches, blood sugar effects, CoQ10 depletion — deserves a real seat at the table rather than being waved away.
The number patients never hear
Here’s the statistic I wish every patient saw before deciding. When you’re told a statin “cuts the risk of death by about 9%,” that’s a relative number, and it sounds enormous. The absolute reduction is far smaller. A 2022 meta-analysis in JAMA Internal Medicine pooling 21 large trials found the absolute reduction in all-cause mortality was roughly 1% — about 0.8% — over the years the trials ran. In plain terms: treat around 100 people with a statin for several years, and on the order of one of them avoids a death who otherwise wouldn’t have.
That can still be worth it for a genuinely high-risk person. But most patients I meet believe a statin is the difference between life and death for them, personally — and the honest math is far more modest than that. You deserve to know the real size of the benefit before you weigh it against anything else.
Now weigh that against what you can do yourself
So ask the obvious next question: if the absolute survival benefit of a statin is on the order of 1%, how much comes from sleeping properly, eating real food, moving your body every day, and managing stress? These aren’t packaged into a single tidy trial the way a drug is, but the evidence consistently links them to substantially larger reductions in cardiovascular and overall mortality — and unlike a statin, they improve nearly everything else about your health at the same time, with no side effects to manage. This isn’t an argument against ever taking a statin. It’s an argument for keeping the pill in proportion, and not letting it crowd out the things that move the needle most.
Why “cholesterol” is the wrong thing to obsess over
Standard panels report LDL-C, but the number that tracks risk more faithfully is ApoB or LDL particle count — how many atherogenic particles you carry, not just how much cholesterol rides inside them. Two people with identical LDL-C can have very different particle numbers, and very different risk. If you’re going to measure something, measure that.
The root causes hiding underneath the number
Here’s what I want patients to understand: a high LDL is often a symptom, not the disease. The upstream drivers — insulin resistance, chronic inflammation, a diet heavy in refined carbohydrates and industrial seed oils, poor sleep, and unmanaged stress — are what turn cholesterol into arterial plaque. Address those, and the whole risk profile often shifts. That’s why my approach starts with diet, metabolic health, and inflammation before, or alongside, any prescription.
How I actually decide with a patient
I look at the full picture: ApoB, markers of inflammation and insulin resistance, blood pressure, family history, and the person’s own goals. A statin is a tool — sometimes exactly the right one, sometimes unnecessary once the root causes are handled. What it should never be is a reflex.
If you’re currently on a statin, do not stop it based on an article. This is a decision to make with your own physician, using your own numbers.
About the author: Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist with more than two decades of experience. He works as a consultant helping patients take a natural, root-cause approach to heart health — through diet, lifestyle, and targeted supplements — seeing patients nationwide via telehealth through Natural Heart Doctor. He is licensed in New York and Tennessee and has been featured as an expert source in Medscape and Men’s Journal. Learn more at andrewrudin.com.
This article is for general educational purposes and is not medical advice. It is not a substitute for care from your own physician, and nothing here should be used to start, stop, or change any treatment on your own.