When a GP diagnoses a patient with high cholesterol, it's likely they will prescribe statins to help lower it. However, statins can produce some negative side effects and cholesterol levels can often be modified with lifestyle changes. So are statins really necessary? We've assembled the research into this simple guide. 

What is cholesterol?

Cholesterol is a fatty substance (a waxy lipoprotein) found in the body, which is produced by the liver and found in some foods. Despite its reputation, cholesterol is vital for a normal, healthy body. Some of the functions of cholesterol include the maintenance of cell walls, supporting the production of bile, and forming hormones.1

What happens if cholesterol becomes too high?

Whether or not a high level of cholesterol is a problem depends on the cholesterol type. There are two main types of cholesterol in the human body: high-density lipoprotein (HDL) and low-density lipoprotein (LDL).1 A healthy level of LDL is essential, but if there is an excess of LDL-cholesterol, it can build up in the walls of blood vessels around the heart. For this reason, LDL is sometimes referred to as 'bad cholesterol', but it is only really 'bad' if it is out of balance with the amount of HDL2 in the body. In the UK, it's advised that total cholesterol should be 5mmol/L or less and LDL should be 3mmol/L or less, although doctors may recommend even lower levels for people at a high risk of heart disease.

What are statins?

If you have a high level of LDL cholesterol and are at a high risk of developing heart disease, or if you have already been diagnosed with heart disease, your doctor may prescribe you a statin. Statins are a group of medications that lower LDL levels by blocking cholesterol production in the liver.

Can statins lower cholesterol and prevent heart disease?

When it comes to lowering LDL cholesterol, statins can be effective at the correct dosage. However, there is uncertainty as to whether they are effective in preventing heart disease. There is evidence to suggest that statins are only effective in certain groups of people. A recent study found that healthy people over 75 that took statins did not see a reduction in heart disease.

Only in a group of people aged 75-84 with type 2 diabetes was there was a reduction in the risk of heart disease.3 In addition, some health experts suggest that statins are only beneficial for people who have already been diagnosed with heart disease. These experts argue that there is not enough evidence to recommend them for people who have never had heart disease.4

What are the risks of statins?

As with many medications, there are known side effects of statin use. The more common side effects include headache, dizziness, nausea, digestive complaints, fatigue and muscle aches and weakness. However, in recent years, there have been a number of reports detailing some potentially more serious statin side effects. In one study, examining the side effects of statin use in post-menopausal women, researchers found that that statin use was associated with a higher risk of type 2 diabetes.5

Given that type 2 diabetes is another risk factor for heart disease, this risk may counteract any potential benefits of statin use to reduce cholesterol for post-menopausal women.5 Statins may also be associated with a higher risk of other health conditions. One piece of research has linked statin use to a higher risk of Parkinson's disease.6 As well as this, there are also several rare but serious side effects. These include myositis, an inflammatory condition of the muscles, and rhabdomyolysis, a type of severe muscle breakdown that can damage the kidneys.7

Natural ways to lower cholesterol

Along with statins, there are natural ways to help balance out your cholesterol levels, whether through lifestyle changes or supplements.

Regular exercise

There are countless studies to support exercise for maintaining healthy cholesterol levels. Research suggests that exercising for at least 30 minutes, 5 times per week is ideal. It's recommended to include both aerobic exercise, such as jogging and swimming, and resistance training, such as weights and bodyweight training.8 For people with limited mobility, it's suggested to increase physical activity as much as possible, using resistance training as a focus.8

If you're not regularly exercising, start slowly and build up your movement, as some movement is better than none at all. If you're not sure what type of exercise suits your mobility, it's best to consult your healthcare practitioner.

Increase your fibre intake

There are two reasons why fibre is a dietary superstar when it comes to lowering cholesterol. Firstly, it prevents bile reabsorption. Cholesterol is used in the production of bile, which is then excreted into the intestines. However, if bile is bound by fibre, this can reduce the amount of cholesterol that is reabsorbed into the body.9

Secondly, fibre helps to slow the absorption of sugar into the bloodstream. As sugar stimulates insulin, and insulin stimulates cholesterol production in the liver, keeping blood sugar steady is essential for healthy cholesterol levels.9 To boost your fibre intake, focus your diet on wholefoods, and include plant-based foods at every meal. Some good options include beans and legumes, oats, wholegrains, fruit, vegetables, nuts and seeds.

Include plant sterols

Plant sterols have a similar structure to cholesterol, which makes them ideal for reducing cholesterol. Including more plant sterols in your diet will trick your body into absorbing them, in turn reducing the amount of cholesterol absorbed from food. Research shows that they may help to reduce cholesterol levels by 5-15%.10 Although plant sterols occur naturally in the diet, it can be difficult to eat enough plant-based foods to achieve a big enough dose. As such, a good quality plant sterol supplement can help to bridge the gap and keep levels in balance.

Krill oil

Omega-3 fatty acids can be a great way of reducing your cholesterol levels naturally — a high strength krill oil supplement can deliver a good amount in one go. Discover more in our guide to balancing cholesterol levels with krill oil.

As with any health concern, be sure to consult your doctor before making any change to your medication routine

For more information on how to keep your heart healthy, see our heart health hub.


References
1 High Blood Cholesterol, National Heart, Lung and Blood Institute
2 High Cholesterol, NHS
3Ramos, R. et al. (2018). Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study. BMJ, 362
4Abramson, J. and Wright, J.M. (2007). Are lipid-lowering guidelines evidence-based?. The Lancet, 369(9557)
5Culver, A.L. et al. (2012). Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Archives of Internal Medicine, 172(2)
6Liu, G. et al. (2017). Statins may facilitate Parkinson's disease: Insight gained from a large, national claims database. Movement Disorders, 32(6)
7Side Effects of Cholesterol-Lowering Statin Drugs WebMD
8Mann, S., Beedie, C. and Jimenez, A. (2014). Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Medicine, 44(2)
9Gunness, P. and Gidley, M.J. (2010). Mechanisms underlying the cholesterol-lowering properties of soluble dietary fibre polysaccharides. Food & Function, 1(2)
10Berger, A., Jones, P.J. and Abumweis, S.S. (2004). Plant sterols: factors affecting their efficacy and safety as functional food ingredients. Lipids in Health and Disease 3(1)

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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