High Cholesterol · Statins · Cholesterol-Lowering Drugs
What Are Statins? A Complete Guide to Cholesterol-Lowering Statin Medication
Medically authored & reviewed by
Dr Abdishakur M Ali
General Practitioner · Telehealth Expert · Clinical Director
Last reviewed: March 2026
GPhC Registered Pharmacy
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Medical disclaimer: This article is for informational purposes only. Our prescribers are GPhC-registered pharmacist independent prescribers.
Statins are the most widely prescribed class of medicines in the UK and are the cornerstone of high cholesterol treatment. By reducing the liver’s production of LDL (“bad”) cholesterol, statins have been shown in multiple large randomised controlled trials to significantly reduce the risk of heart attacks, strokes, and cardiovascular death. This guide explains what statins are, how they work, the different types available, and how to take them safely.
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Start Consultation →✓ GPhC-registered pharmacy #9011198 ✓ Pharmacist independent prescribers ✓ Discreet next-day deliveryHow Statins Work to Lower Cholesterol
Statins inhibit HMG-CoA reductase — the rate-limiting enzyme in the liver’s cholesterol synthesis pathway. This reduces the liver’s internal cholesterol production. In response, the liver upregulates the number of LDL receptors on its surface to obtain the cholesterol it needs from the bloodstream. This dual mechanism:
- Reduces the total amount of cholesterol the liver produces
- Increases the liver’s removal of LDL cholesterol from the bloodstream
- Leads to a net reduction in total and LDL cholesterol levels in the blood
- Reduces the formation of arterial plaques (atherosclerosis) over time
For more on how high cholesterol damages arteries and its causes, see our guides to what is high cholesterol? and what causes high cholesterol?
The Five Types of Statins Available in the UK
| Statin | Brand Names | Potency | Dose Range | Key Notes |
|---|---|---|---|---|
| Atorvastatin | Lipitor and generics | High | 10–80mg daily | Most widely prescribed; take any time; minimal grapefruit interaction |
| Rosuvastatin | Crestor and generics | High | 5–40mg daily | Most potent per mg; take any time; no grapefruit issue |
| Simvastatin | Zocor and generics | Moderate | 10–40mg daily (evening) | Take in evening; avoid grapefruit; fewer drug interactions at 20–40mg |
| Pravastatin | Lipostat and generics | Low-moderate | 10–40mg daily | Fewest drug interactions; safer in liver or muscle conditions |
| Fluvastatin | Lescol and generics | Low-moderate | 20–80mg daily | Capsules (evening) or extended-release tablets (any time) |
Who Should Take Statins?
NICE recommends statins for:
- All people with a 10-year cardiovascular disease risk of 10% or more (calculated using QRISK3)
- People with established cardiovascular disease (history of heart attack, stroke, TIA, peripheral arterial disease)
- People with type 1 or type 2 diabetes (particularly those over 40 or with additional risk factors)
- People with familial hypercholesterolaemia — usually requires high-intensity statin therapy
- People with chronic kidney disease (with appropriate dose adjustment)
NICE recommends starting with atorvastatin 20mg for primary prevention (preventing first cardiovascular event) and atorvastatin 80mg for secondary prevention (after a cardiovascular event).
Statin Side Effects: What to Watch For
| Side Effect | How Common | Action |
|---|---|---|
| Muscle aches (myalgia) | Common (1–5%) | Discuss with prescriber; may resolve with dose reduction or switch to different statin |
| Headache, nausea, indigestion | Common | Usually mild and temporary; take with food if needed |
| Raised blood glucose | Uncommon | Relevant for people with diabetes or prediabetes; monitor glucose |
| Liver enzyme elevation | Uncommon | Monitoring blood tests in first year; stop if levels markedly elevated |
| Rhabdomyolysis (serious muscle breakdown) | Rare (<0.01%) | Seek urgent medical attention if severe muscle pain, weakness, or dark urine |
| Memory/cognitive effects | Unclear | Rare reports; discuss with prescriber if concerned |
Red flag — stop statins and seek urgent medical attention if you develop: severe unexplained muscle pain or weakness, dark tea-coloured urine (indicating myoglobulin in urine from muscle breakdown), or jaundice (yellowing of skin/eyes).
For detailed information on simvastatin specifically, see our guide to simvastatin for cholesterol management.
More High Cholesterol Guides from Access Doctor
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Order Statins →✓ GPhC-registered pharmacy #9011198 ✓ Pharmacist independent prescribers ✓ Discreet next-day deliveryFrequently Asked Questions
What are statins and what do they do?
Statins are a class of prescription medicines that reduce the amount of LDL (‘bad’) cholesterol produced by the liver. They work by inhibiting HMG-CoA reductase — the key enzyme in the liver’s cholesterol synthesis pathway. By lowering LDL cholesterol, statins reduce atherosclerosis and significantly lower the risk of heart attacks and strokes.
Which is the most effective statin?
Rosuvastatin and atorvastatin are the most potent statins per milligram. For most patients, high-intensity statin therapy (atorvastatin 40–80mg or rosuvastatin 20–40mg) is recommended to achieve the greatest LDL reduction and cardiovascular risk reduction. Your prescriber will choose based on your risk level and any drug interactions.
What are the most common side effects of statins?
The most common side effects are muscle aches (myalgia), headache, nausea, and mild gastrointestinal disturbance. Serious muscle damage (rhabdomyolysis) is rare but requires prompt medical attention. Statins can also cause a small increase in blood glucose. Liver problems are rare but monitoring with blood tests is recommended in the first year.
Can statins be stopped suddenly?
You should not stop taking statins without discussing it with your prescriber. Stopping statins abruptly can cause a rapid rebound in LDL cholesterol levels. If you are experiencing side effects, discuss alternatives or dose adjustments rather than stopping. Switching between statins is often an effective solution for intolerance.
Do I need to take statins for life?
In most cases, yes. Statins are long-term preventive medicines. High cholesterol typically requires ongoing treatment to keep levels in the safe range. If the indication was very high cardiovascular risk, statins are usually lifelong. However, if significant lifestyle changes achieve target cholesterol levels, your prescriber may review the need for continued medication.
Can I drink grapefruit juice while taking statins?
Grapefruit and grapefruit juice significantly increase the blood levels of simvastatin and lovastatin (and to a lesser extent atorvastatin), raising the risk of side effects. Avoid grapefruit juice with these statins. Pravastatin, rosuvastatin, and fluvastatin are not significantly affected.
References
- NICE. Cardiovascular disease: risk assessment and reduction (CG181). Updated 2023. nice.org.uk/guidance/cg181
- NHS. Statins. nhs.uk/conditions/statins
- Collins R et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016. pubmed.ncbi.nlm.nih.gov
- GPhC. Standards for registered pharmacies. pharmacyregulation.org
Access Doctor is a GPhC-registered online pharmacy (registration number 9011198). All prescriptions are issued by GPhC-registered pharmacist independent prescribers. Medicines are MHRA-compliant UK-licensed products.