Are you concerned about statins? In the past two weeks, cold hard statistics have cut through the fog of misinformation surrounding these best-selling drugs, focusing instead on the safety and efficacy of lowering your blood cholesterol level. No emotions or bias, just numbers. Welcome information for anyone who has enjoyed numerous trips around the sun and is looking forward to many more.

Middle age, that point in life when your invincibility fails, can be tough. Bad news gains momentum, and tales of cancer and heart disease are no longer just a concern of your parents’. I wait nervously in the doctor’s office as they frown slightly and go over my chart. I am contemplating the very worst news, a recommended lifestyle change. I decide I can live with chair yoga, as long as my friends do not find out, but I will draw the line at celery.

The news could have been worse. My cholesterol, the “bad” kind, is only a bit high, and my doctor recommends a low-dose statin to be safe. And yet I feel fine. There is no immediate problem, the doc explains, they simply want to “change the trajectory” of my heart disease. Wait, what trajectory?

I have questions. Am I at risk of a heart attack, like my father and his father before him? Should I be on a statin, the poster child of cholesterol-lowering drugs? Do they really work? What about the side effects?

Peace of mind, powered by numbers

Many of these questions have been answered by two recent clinical studies known as meta-analyses, the gold standard of medical evidence. Using statistics to separate the science from the non-science, here is what the number-crunchers found.

• Cholesterol-lowering drugs like statins will, on average, extend your life.
• All cholesterol-lowering drugs (statins, ezetimibe, PCSK9i, and the recently approved bempedoic acid) are capable of delaying and possibly preventing your first heart attack.
• Statins, the best value for money, have far fewer side effects than what you may see listed on the container.

Cholesterol, which is no longer the only villain in the heart disease story, is still a convenient marker to track the progress of the disease. Better yet, drugs that lower cholesterol also reduce the true culprit, a protein called apoB, as well as lower chronic inflammation, providing patients with a double bang for their buck in limiting their risk of a heart attack. Testing blood cholesterol is quick, cheap, and backed by several decades of data, a convenient tool with which physicians can estimate your risk of heart disease.

The upside: how small numbers affect millions

The first study followed nearly 100,000 middle-aged people who had no prior history of heart disease. It measured the fate of people on cholesterol-lowering therapy, mostly statins, with those who had not been treated. The medical events they were looking for sound grim indeed: death, non-fatal heart attack, stroke, and if caught in time, surgical procedures to prevent all the above.

The results: People on any low-dose cholesterol-lowering therapy had a 30 percent lower chance of experiencing an “event” than their unmedicated counterparts. The survival benefits were even greater for those on higher doses of medication.

But what does a 30 percent benefit actually mean? During the four-year duration of the study, a small number of participants experienced a cardiac event. Those on cholesterol-lowering drugs had 30 percent fewer events relative to those not on any medication. This suggests that a statin, even in people without symptoms of heart disease, provided an immediate benefit to life expectancy.

Now let us include all the relatively healthy participants and look at the benefits to the group as a whole. What were the absolute benefits for the 100,000 middle-aged men and women who began therapy before symptoms of heart disease were detected? That is you, right? Better check!

The absolute benefit to the drug group over the drug-free was 2 percent. At first glance this may not impress, one life was saved for every 50 people on cholesterol-lowering therapy over the four-year period. Before deciding whether you can live with, or die from, those odds, one has to consider two factors, the scale of the problem, and time. Here are the facts.

• Every year, an estimated 850,000 Americans die from heart disease or stroke, the 2 percent absolute benefit represents a sizable number of lives saved.
• Heart disease develops over several decades, not the short four-year window of the study. The benefits of lowering cholesterol in your body compound over your lifetime, suggesting that the sooner you begin therapy, the better your outcomes would be.
• It is not today’s cholesterol that is the problem, but rather your accumulated cholesterol load over your lifetime.

The downside: facts before fears

Statins, however, are notorious for their unpleasant side effects, with countless social media channels, websites, and blogs dedicated to exposing the downside of these drugs. Enter the second study which looked to see if the dire warnings printed on the drug labels were accurate. It followed over 120,000 people on statin therapy for five years and compared side effects reported by users with a drug-free population. A big plus: The studies pooled in the analysis were “double-blinded”, neither the patients nor their physicians knew if they were on a statin or a sugar pill. This ensured that any side effects that predominated in the statin group would likely be caused by the drug, whilst side effects common to both groups were not.

Sixty-six potential side effects were compared between the statin and the control group with only one new symptom, raised liver enzymes, being elevated in the statin group. The finding joins the previously recognized conditions of muscle pain (myalgia) and new-onset diabetes associated with statin use, and occurred in a handful of extra cases per year among statin users. The enzymes were not sufficiently elevated to affect health.

The remaining 62 side effects, which included brain fog, depression, sleep disturbances, and sexual dysfunction, occurred at similar rates in both groups.

Could your doctor be right?

Sometimes the hardest pill to swallow is admitting that the best medical evidence we have is accurate. Today Americans have more choice than ever when it comes to cholesterol-lowering drugs. If one does not agree with you, your doctor can prescribe another.

It all comes down to shifting the probabilities of survival in your favor. Your family will thank you, probably.

Cliff Dominy is a medical writer.