Walter Willett: On Getting off Statins

A 60-year-old woman who has been taking a low-dose statin for 15 years wants to stop because of side effects. Her cholesterol is below 200, she eats a prudent diet, keeps her blood pressure under control with medication, and exercises for 30 minutes four days a week. Is it possible to go off statins under those circumstances?

Walter Willett: Statins are not necessarily for life if changes and diet and activity are sufficient to keep cholesterol under control. However, many people who think they are on a "prudent" diet are often focusing on reduction of overall fat in the diet. This is not the best way to improve blood cholesterol levels because unsaturated fats actually reduce LDL (bad) cholesterol.

It would be good to get a detailed consultation about diet, possibly with a dietitian, to be sure that the dietary strategy is really on target, both for control of blood cholesterol levels and for control of blood pressure. Also, total cholesterol level is not really a good guide to the need for medication. Risk of heart disease really depends on the amounts of LDL and HDL (good cholesterol) in the blood, and it is possible that this woman really has perfectly healthy cholesterol fractions. It would be good to ask her physician to check LDL and HDL and review these numbers. Even more important is to know whether this woman smokes (much more important than blood cholesterol numbers) and what her BMI is (based on weight and height), because this strongly predicts risk of diabetes, cancer, and many other outcomes in addition to cardiovascular disease.