Statin therapy plays an important role in stroke prevention and recovery by lowering cholesterol, reducing inflammation and stabilizing plaque in the arteries. For people at risk of stroke or those recovering from one, statins may help reduce the risk of a first or recurrent stroke when combined with healthy lifestyle changes and guidance from a healthcare provider.
Statins are medications used to reduce cholesterol in the liver and bloodstream. There are different types of cholesterol. Low-density lipoprotein (LDL) is often referred to as "bad" cholesterol. High-density lipoprotein, HDL, is known as the "good" cholesterol because it helps reduce LDL in your arteries. Triglycerides are fats in your bloodstream that can contribute to plaque buildup in blood vessels.
Total blood cholesterol includes LDL, HDL and 20% of your triglyceride level.
Statins are most effective in reducing LDL cholesterol. Your doctor may prescribe statin therapy if your cholesterol and triglyceride levels are elevated, since these factors are linked to heart disease and stroke.
Understanding how statins work
Statins block the enzyme the body uses to make cholesterol. This reduces the amount of cholesterol produced in the liver. Statins also increase the number of LDL receptors on liver cells, which helps remove LDL from the bloodstream. They may slightly raise HDL cholesterol and reduce triglyceride levels.
In 2022, the U.S. Preventive Services Task Force (USPSTF) released updated guidelines on the use of statins to prevent a first heart attack or stroke. These guidelines suggest that adults ages 40-75 who have cardiovascular disease risk factors and a 10% or higher risk of having a heart attack or stroke within the next 10 years may benefit from statin therapy. For people with a lower risk, between 7.5%-10%, the recommendation is to talk with a doctor about whether statin therapy is appropriate.
No recommendation was provided for adults older than 75. If you fall into this age group, the USPSTF suggests working with your doctor to decide whether starting statin therapy is right for you. While studies show benefits of statin therapy may continue at older ages, older adults often take more medications, which can increase the risk of drug interactions.
Other organizations, such as the American College of Cardiology and the American Heart Association recommend a more aggressive approach. They advise starting statins for adults ages 40-75 with a 7.5% or higher risk, diabetes or very high cholesterol levels.
Types of statins
Statins are affordable, effective and widely prescribed. They are available as tablets or capsules and come in both brand-name and generic forms. An estimated 40 million Americans take statins.
Once you begin taking a statin, it is usually intended as a long-term medication. In some cases, weight loss or lifestyle changes may improve cholesterol level enough to reassess treatment. It is important to take statins exactly as prescribed and not stop taking them unless your doctor advises you to do so.
Side effects of statins
Most experts agree that statins are highly effective in lowering cholesterol and reducing the risk of heart attack and stroke. When taken as prescribed, statins are considered safe for most people.
The U.S. Food and Drug Administration (FDA) recommends checking liver enzyme levels before starting statin therapy. Routine liver testing is not required unless symptoms develop or your doctor recommends it.
Statins are generally well tolerated, but some side effects may occur, including:
- Muscle pain, cramps or weakness, the most common side effects
- Headache, which often improves as the body adjusts
- Fatigue in a small number of people
- Nausea, vomiting and diarrhea in some patients
If you experience side effects, talk with your doctor. Options may include adjusting the dose, switching medications or reviewing other prescriptions that could interact with statins. Do not stop taking a statin without consulting your physician.
How statin therapy supports stroke prevention
According to the American Stroke Association, stroke is the fourth leading cause of death. Statins are just one tool used to help reduce the risk of heart attack and stroke.
A heart-healthy lifestyle is a major factor in reducing atherosclerotic cardiovascular disease (ASCVD). The American Heart Association recommends:
- Eating a variety of fruits, vegetables, whole grains and healthy proteins
- Choosing low-fat or nonfat dairy
- Eating lean, unprocessed meat and poultry
- Limiting added sugars and salt
- Using liquid, non-tropical vegetable oils
- Limiting or avoiding alcohol
- Avoiding tobacco and nicotine
Additional steps that support heart health include regular physical activity, maintaining a healthy weight, managing stress, getting enough sleep and having routine health checkups.
If lifestyle changes are not enough to control cholesterol, or if you are at high risk for cardiovascular disease, your doctor may recommend statin therapy. Statins have been shown to reduce the risk of ischemic stroke and may be prescribed even when cholesterol levels are normal if other risk factors are present.
In addition to lowering cholesterol, statins help reduce inflammation, stabilize plaque in the arteries and lower the chance of blood vessel blockage. Studies show that people who were taking statins before an ischemic stroke may have better outcomes, especially with small vessel strokes.
Statins and stroke recovery
Statin medications play an important role in preventing a second stroke. Standard post-stroke therapy often includes a high-intensity statin to lower LDL cholesterol.
The 2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (TIA) recommends atorvastatin 80 mg daily for certain patients with LDL levels above 100 mg/dL and no known coronary artery disease or major cardiac source of embolism. For people who have had a stroke or TIA and have confirmed atherosclerosis, the goal is to use statin to lower LDL to less than 70 mg/dL.
If LDL levels remain elevated despite maximum statin therapy, a non-statin medication such as ezetimibe may be added.
Is statin therapy right for you?
Before starting statin therapy, talk with your doctor about the potential benefits and risks. Questions to consider include:
- What are my cholesterol numbers?
- What is my risk of heart attack or stroke?
- Does the benefit of statin therapy outweigh the risks for me?
- How will we assess whether the statin medication is working?
- Could lifestyle changes affect my need for a statin?
- What side effects should I watch for?
- What follow-up care or testing will I need?
- What are my options if I can’t tolerate a statin?
When combined with lifestyle choices and management of other chronic conditions, statins are safe for most people and play a key role in reducing stroke risk and supporting recovery.