Can you stop taking statins?

In this article:

• Can you stop taking statins?
• Reasons to stop
• How to stop taking statins
• Alternative treatments
• The bottom line

In this article

• Can you stop taking statins?
• Reasons to stop
• How to stop taking statins
• Alternative treatments
• The bottom line

Statins are a class of medications prescribed to people with high cholesterol levels, including Crestor (rosuvastatin), Lipitor (atorvastatin), and Zocor (simvastatin). They lower your low-density lipoprotein (LDL) cholesterol (the bad kind) and your triglyceride levels, which can help give you better total cholesterol levels. In addition to treating high cholesterol, statins can also be used to prevent heart attack and stroke in people with heart disease or who are at risk of heart disease because they have clogged arteries.

Some people taking statins are able to stop treatment, but it depends on why your provider prescribed them to you and your overall health. Here’s what to know about stopping statins, from why it might happen and how to do it safely to the possible benefits and risks.

What happens if you stop taking statins?

It’s possible for some people to stop taking statins after beginning treatment, but your individual risk factors play the biggest role here. If you have major cardiovascular risk factors like a previous stroke or heart attack, you’re probably not a candidate for coming off statins, according to Joyce Oen-Hsiao, MD, associate professor of medicine at Yale School of Medicine. But if you were on statins for what experts call “primary prevention,” or preventing heart attack and stroke in someone with no history of either condition, statins may not need to be a lifelong treatment.

“The majority of times when I could take someone off a statin [was when] they had high cholesterol from poor lifestyle choices and we had to put them on [one] for primary prevention,” says Dr. Oen-Hsiao. “If a person is able to exercise and changes their diet enough to get their cholesterol levels to goal, it is possible for them to come off of statins.” 

Without making lifestyle changes, however, stopping statins almost always means your cholesterol levels will rise again—potentially to dangerous levels, increasing your risk for heart disease and cardiovascular events like heart attack, stroke, and aneurysm. 

Reasons for stopping statins 

Depending on your risk factors, your provider may recommend that you stay on statins indefinitely unless you have a serious reason to stop. 

This is especially true for people who have already had a cardiovascular event, says Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California. Most providers won’t discontinue a statin for a high-risk person unless they experience side effects. In those cases, Dr. Chen says, you would probably be switched to a non-statin cholesterol-lowering drug instead.

Common side effects of statins include muscle pain, high blood sugar, and elevated liver enzymes. Some people have no side effects; others have mild or temporary side effects. But for some, these side effects can persist, affect quality of life, or even cause serious damage to the liver and muscles. If your side effects are ongoing or severe, talk to your provider. They will probably switch you to another medication with fewer side effects that still works to control your cholesterol levels.

In addition to side effects, there are some other reasons people may stop taking their statins, including:

• Better health choices: Dr. Chen says you could potentially be given the green light to stop taking statins if your cardiovascular risk becomes lower than it was before. Usually, this happens when statins are prescribed for primary prevention, and then you make enough lifestyle changes to significantly lower your cholesterol levels. Just having lower cholesterol levels alone is often not enough for statin discontinuation. There’s a good chance those lower numbers are thanks to the medication, and stopping it will cause your levels to rise again.  
• Cost: There are many different types of generic and brand-name statins, so there’s a good chance that at least one statin medication will be covered under your health insurance plan. However, if you don’t have coverage for statins or don’t have health insurance, it could be expensive to continue taking statins. Talk to your healthcare provider if you’re having trouble affording your medication. They can work with you to create a treatment plan that fits your budget and addresses your symptoms.
• Pregnancy: Statins are usually not considered safe to use during pregnancy or breastfeeding, but they may not be as risky as experts have thought in the past. If you’re taking statins and become pregnant, talk to your healthcare provider. They can help you weigh the pros and cons of stopping statins for the length of your pregnancy (and beyond, if you’re planning to breastfeed), and help you find other ways to manage your cholesterol levels if you choose to stop taking statins for a long period of time.
• Medication interactions: Statins can interact with several other prescription medications, including some antibiotics and antifungals, protease inhibitors (used to treat HIV and Hepatitis C), and other cholesterol medications. If you need to be on a drug that interacts with statins, your provider may tell you to stop taking your statin.

How to stop taking statins

You should never stop taking statins (or any prescription medication) without talking to your provider first. Some medications can be stopped suddenly, but others—like statins—usually need to be tapered. Stopping suddenly can increase your risk for a heart attack and stroke, especially if you’ve already had a cardiovascular event. Always work with your provider to find the safest plan for you.

Here are some of the common approaches your provider may suggest instead of abruptly ending treatment:

1. Tapering off gradually

Tapering a medication means you slowly take less and less over a period of days or weeks until you are no longer taking any of the medication. This gives your body time to acclimate to having less of the drug in your system.

Abruptly stopping is generally not considered safe, especially for people who have already had a cardiovascular event. Their protective effect goes away fairly quickly, per Dr. Chen, so you need to have a lifestyle plan in place to reduce the future risk of heart disease.

2. Lowering the dose or combining with a non-statin

Another reason it’s important to talk to your provider before stopping statins? You may not need to completely discontinue treatment. Some people can manage their cholesterol with a lower dose of their medication or by combining a low-dose statin with a non-statin medication. Your healthcare provider may talk to you about the “rule of 7” when calculating or adjusting your statin dose: this means that every time you double your dose, you can expect an additional 7% reduction in LDL cholesterol, per Dr. Oen-Hsiao. 

The “rule of 7” means higher statin doses don’t equal a significantly higher reduction in cholesterol. In other words, if you double your dosage, you won’t double your LDL cholesterol reduction. It also means lower doses can be pretty effective in managing cholesterol levels.

“Some people are unable to tolerate higher doses of statins,” says Dr. Oen-Hsiao, “[but] we have non-statin cholesterol medications that we can give in addition to a lower-dose statin to try to get their cholesterol under control.”

3. Switching to a different statin

Finally, even though all statins come with possible side effects, your body may be able to tolerate another statin medication better. For example, you could have serious muscle pain on Crestor but not on Lipitor. Your provider may suggest you switch to a different statin before choosing to stop taking them completely.

Alternatives to statin therapy

Depending on your original reason for taking statins and your overall health, you may be able to use lifestyle changes, non-statin medications, or supplements to help maintain a healthy cholesterol level instead.

Lifestyle changes 

There are three major lifestyle changes you can make that might make it possible to treat your high cholesterol without statins.

1. Diet: Drs. Chen and Oen-Hsiao both recommend following a heart-healthy diet that’s high in fiber, whole grains, monounsaturated fats (like omega-3 fatty acids), fruits, and vegetables. They also advise against eating a lot of saturated fats, sugary foods, fried foods, and refined carbohydrates.
2. Exercise: Regular physical activity can help you maintain a healthy weight and keep your heart strong. Aim for at least 30 minutes of cardio exercise every day, per Dr. Oen-Hsiao.
3. Healthy habits: Dr. Chen recommends that people avoid smoking and excess alcohol consumption if they are trying to avoid statins, since both are linked to a higher risk of heart disease.

Medications 

If you can’t take statins but still need help managing your cholesterol level, you may be a candidate for a non-statin cholesterol medication. These medications also lower your LDL cholesterol but work differently from statins, and some of them are not as effective as statins when used alone.

These medications include:

• PCSK9 inhibitors like Praluent (alirocumab) and Repatha (evolocumab)
• Zetia (ezetimibe), a cholesterol absorption inhibitor that reduces the amount of cholesterol in the intestines and liver
• Nexletol, an antilipemic drug containing bempedoic acid to decrease the amount of LDL in your blood
• Leqvio (inclisiran), an injectable PCSK9 inhibitor

Fibrates such as Lopid (gemfibrozil) and Tricor (fenofibrate) can sometimes be used, but they don’t lower LDL cholesterol—only triglycerides. Therefore, they may not be an option for everyone trying to avoid statin therapy.

Supplements

A few supplements could potentially work as an alternative to statins, but there are limitations. 

Dr. Oen-Hsiao says some supplements can be helpful in lowering cholesterol, but there are no good clinical trials studying their safety, and they don’t reduce cholesterol levels as well as statins. Dr. Chen agrees, noting there may also be other side effects and drug interactions to consider when taking supplements. You should never take a supplement with a prescribed statin unless your provider says it’s okay to combine them.

• Red yeast rice:  One study found that this extract may help lower mild to moderately high cholesterol in people with no other major risk factors.
• Fish oil: A meta-analysis of studies suggests higher doses of omega‐3 fatty acids may reduce triglycerides and LDL cholesterol.
• Niacin: High doses of niacin (B3) have some evidence for reducing LDL cholesterol and triglycerides while increasing HDL cholesterol (the good kind). However, newer research has also found high levels of niacin to be a risk factor for heart disease, and some experts are moving away from recommending it. 

The bottom line

Statins are usually prescribed to help prevent cardiovascular events like heart attack and stroke in people who are at high risk. Sometimes this is because you’ve already had a cardiovascular event, and other times it’s because your cholesterol levels are much higher than they should be (or both). 

It may be possible to stop taking statins, but it depends on why they were prescribed to you in the first place. People using statins for primary prevention may be able to stop taking them, but not without making major lifestyle changes to lower their cholesterol levels. Most people who have already had a heart attack or stroke shouldn’t stop taking statins unless they can’t tolerate the side effects.  

If you’re experiencing statin side effects, your provider may suggest lowering your dose or switching to another statin before recommending you stop taking it entirely. While some other therapies can lower your cholesterol levels, statins are one of the most effective ways to reduce your risk of heart attack and stroke—so never stop taking them without talking to your provider first.