Statins lower LDL (“bad”) cholesterol and reduce heart attacks and strokes, with the largest benefit for people at higher risk. In blinded trials, about 1 in 100 people had muscle aches caused by the statin itself. Whether you need one depends on your 5-year risk, or on whether you already have heart disease.
What statins are and how they work
Statins are tablets that lower LDL cholesterol. LDL particles can lodge in the walls of your arteries and build up into plaque over many years, raising the risk of heart attack and stroke.
Statins slow an enzyme in your liver that makes cholesterol. The liver then pulls more LDL out of your blood. Lower LDL helps stop new plaque forming and may make existing plaque more stable, so it is less likely to break open and cause a heart attack or stroke.
Who statins are recommended for
If you do not have heart disease, there is no Australian LDL target. Medication is usually recommended if your 5-year risk on the Australian CVD risk calculator is 10% or more, and discussed with you if it is 5% to under 10%. People with known heart or blood vessel disease, confirmed familial hypercholesterolaemia (FH) or moderate to severe kidney disease are treated as high risk without the calculator. Family history or a coronary calcium score can move you into a different risk group.
The risk groups, LDL goals for people with heart disease and the other situations where treatment is recommended are explained in high cholesterol explained.
The benefits
Large trials involving hundreds of thousands of people show that statins reduce heart attacks and strokes. How much you gain depends on your starting risk, so people at higher risk gain the most.
You may also see percentages. In trials of people without known heart disease, statins lowered heart attacks by 33%, strokes by 22% and deaths from any cause by 8% (USPSTF review, Chou JAMA 2022). These are relative reductions: they describe a share of your starting risk, so the lower your risk, the smaller the real gain. Your doctor can turn them into numbers for you.
Side effects
The most reliable information comes from blinded trials, where neither the patient nor the doctor knows who is taking a statin and who is taking a dummy pill (placebo).
Muscle aches
More than 9 in 10 reports of muscle pain in people taking a statin were not caused by the statin. When people expect a side effect, they are more likely to notice symptoms (the nocebo effect). Your symptoms are real, but the statin may not be the cause.
Serious muscle injury
Severe muscle breakdown (rhabdomyolysis) is very rare, affecting fewer than 1 in 10,000 people a year. Tell your doctor promptly about severe muscle pain, weakness or dark urine.
Liver tests
A mild rise in liver tests happens in about 1 in 100 people and usually settles. Serious liver injury is very rare. Most people do not need routine liver blood tests.
Diabetes
Statins slightly raise the chance of type 2 diabetes: about 1 to 2 extra cases per 1,000 people a year, mostly in people whose blood sugar is already close to the diabetes range (CTT 2024).
Large trials have not shown that statins cause cancer, memory loss or cataracts. Statins are usually stopped when planning a pregnancy; if you have familial hypercholesterolaemia or heart disease, discuss this with your specialist first.
If you get side effects
Do not stop your statin suddenly without talking to your doctor, because stopping can raise your risk of a heart attack or stroke. Your doctor may first look for other causes of aches, which become more common with age, exercise and other health conditions.
Many people who have trouble with one statin do well on a different one, or on a lower dose. Taking a statin every second day or twice a week is another option. It still lowers LDL, but it has not been tested in trials that measure heart attacks and strokes.
How much each treatment lowers LDL
If a statin does not suit you, or your LDL is still above your goal, there are other options. They differ in how much they lower LDL.
Typical LDL reduction from the starting level. Sources: ESC/EAS 2019 dyslipidaemia guidelines and 2025 focused update.
Ezetimibe
A tablet that is generally well tolerated and often combined with a statin. PBS-subsidised.
Another tablet that lowers LDL
In a trial of people who could not take statins (CLEAR Outcomes), heart attacks and strokes were modestly reduced. As of October 2026 it is not PBS-subsidised, so ask your doctor about cost.
Injectable LDL-lowering medicines
Lower LDL by about 50–60%. They are PBS-subsidised for some people at very high risk whose LDL stays high despite tablets. Your doctor can check whether you qualify.
Lifestyle changes are the foundation for everyone. They usually lower LDL by about 5–15%, so for many people at higher risk they are not enough on their own. See how to lower cholesterol without medication.
Questions to ask your doctor
The decision to take a statin is a personal one, based on your risk, your goals and your preferences.
- What is my 5-year risk on the Australian CVD risk calculator?
- How much would a statin lower my risk, in numbers?
- What side effects should I look out for, and what can we do if they happen?
- What could I do instead, or as well, if I am unsure about a statin?
Frequently asked questions
Are statins dangerous?
Statins are among the most studied medicines. Serious side effects are uncommon, and the benefit in preventing heart attacks and strokes is well established, especially for people at higher risk.
Are natural supplements a safer choice?
“Natural” does not mean safe or effective. Red yeast rice contains the same active ingredient as one statin, in unregulated amounts. No supplement sold in Australia has been shown to reduce heart attacks or strokes.
Can I stop my statin if my cholesterol is now normal?
Usually not. Your cholesterol is lower because of the statin, and it generally rises again within weeks of stopping. Talk to your doctor before making any change.
For referring doctorsClinical notes for GPs
- Refer when: LDL above the goal stated in Dr Ng's letter on maximally tolerated statin plus ezetimibe, intolerance to two or more statins, suspected FH, or CK above 10× ULN.
- Send: lipid history (including pre-treatment LDL), statins and doses tried with symptoms, CK and TSH if muscle symptoms, eGFR, AusCVDRisk score and family history.
- Medicines (indication): treat at 10% or more 5-year AusCVDRisk and in clinically high-risk groups: known CVD, confirmed FH, moderate-to-severe CKD (sustained eGFR <45 and/or persistent uACR >25 mg/mmol men, >35 mg/mmol women); also irrespective of calculated risk if TC >7.5 mmol/L or BP >160/100. Consider at 5–<10% with shared decision-making. CAC 0 may reclassify lower; >99 or ≥75th percentile may reclassify higher; 1–99 below the 75th percentile: individualise. (2023 Australian CVD risk guideline; NHFA CAC position statement, MJA 2021)
- Medicines (benefit and harms): absolute benefit about 10 per 100 over 5 years with established vascular disease, about 5 per 100 at increased risk without it, per 2 mmol/L LDL lowering (Collins 2016). Relative reductions in primary prevention: MI 33%, stroke 22%, all-cause mortality 8% (Chou 2022). About 1 in 100 muscle symptoms attributable (CTT 2022); diabetes about 1–2 extra per 1,000 per year (CTT 2024). Usually stopped when planning pregnancy; discuss with the specialist first in FH or established ASCVD.
- Medicines (escalation and intolerance): no Australian LDL target in primary prevention. Established coronary disease (including obstructive plaque on CTCA) and after ACS: LDL below 1.4 mmol/L and at least a 50% reduction (ESC 2024 chronic coronary syndromes guideline; after ACS, NHFA/CSANZ 2025). Non-obstructive plaque on CTCA: Dr Ng usually aims for LDL below 1.8 mmol/L, or below 1.4 mmol/L in people at higher risk. Add ezetimibe if above goal. Rechallenge with a different or lower-dose statin; alternate-day rosuvastatin or atorvastatin lowers LDL (no outcome trials). Bempedoic acid: CLEAR Outcomes MACE down 13%, MI down 23%. Review CYP3A4 inhibitors, ciclosporin, gemfibrozil and grapefruit with simvastatin or atorvastatin.
- Monitoring: no routine repeat LFT or CK without symptoms. Recheck lipids at 4–12 weeks, then every 3–12 months.
- PBS/MBS: statins and ezetimibe are Unrestricted Benefits. Evolocumab and inclisiran are Authority Required for HeFH or ASCVD above PBS LDL thresholds. Bempedoic acid was considered by the PBAC in July 2026; as of October 2026 it is not PBS-listed. Check pbs.gov.au.
General information for referring practitioners. Check current MBS and PBS criteria before acting.
References
- Nelson MR, Banks E, Brown A, et al. 2023 Australian guideline for assessing and managing cardiovascular disease risk. Med J Aust. 2024;220(9):482-490. doi:10.5694/mja2.52280
- Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388(10059):2532-2561. doi:10.1016/S0140-6736(16)31357-5
- Chou R, Cantor A, Dana T, et al. Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022;328(8):754-771. doi:10.1001/jama.2022.12138
- Cholesterol Treatment Trialists' Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet. 2022;400(10355):832-845. doi:10.1016/S0140-6736(22)01545-8
- Cholesterol Treatment Trialists' Collaboration. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials. Lancet Diabetes Endocrinol. 2024;12(5):306-319. doi:10.1016/S2213-8587(24)00040-8
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455
- Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025;46(42):4359-4378. doi:10.1093/eurheartj/ehaf190
- Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic acid and cardiovascular outcomes in statin-intolerant patients. N Engl J Med. 2023;388(15):1353-1364. doi:10.1056/NEJMoa2215024
- Jennings GLR, Audehm R, Bishop W, et al. National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia. Med J Aust. 2021;214(9):434-439. doi:10.5694/mja2.51039
- Brieger D, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025. Med J Aust. 2026;224(2). doi:10.5694/mja2.70127
- Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-3537. doi:10.1093/eurheartj/ehae177