- Statin cholesterol medications are some of the most commonly prescribed medications in the U.S.
- Statins can be broken into three categories: low intensity, moderate intensity, and high intensity.
- High intensity statins are generally given to people most at risk for heart-related complications due to high cholesterol.
There’s a good chance that you or someone you know is taking a statin medication for high cholesterol. Statins are some of the most commonly prescribed medications in the U.S. In fact, it was estimated that about 1 in 4 adults over the age of 40 took a statin in 2012. And as of November 2021, GoodRx reported the most filled medication in the U.S. is atorvastatin (Lipitor).
Statin is a short name for a group of medications called HMG-CoA reductase inhibitors. The medication names in this group all end with “-statin.” Statins work by helping to lower the amount of cholesterol made by your liver. They also help your liver get rid of cholesterol that’s in your bloodstream. Statins can help lower the risk of heart problems for some people.
But which statin and strength a person takes often depends on their heart health risks. You may have heard of different terms, like low or high intensity statins. But what do these terms mean?
Here, we’ll discuss what statin intensity means and who could benefit from a high intensity statin.
What does statin intensity mean?
In short, statin intensity refers to how powerful a statin is. Every statin has different doses available. Generally, the higher their doses, the more they lower your low-density lipoprotein (LDL) cholesterol. LDL is sometimes called “bad” cholesterol because high levels of LDL can raise your risk for heart disease.
Some statins lower LDL better than others. A high-dose statin isn’t necessarily a high intensity statin. This is something to keep in mind about these medications. Even though they all follow the same steps in the body to lower LDL, some are more effective at this job than others.
Statins can be placed into three different categories based on how much they can lower LDL:
- Low intensity statins: these can lower LDL by no more than 30%.
- Moderate intensity statins: these can lower LDL between 30% and 49%.
- High intensity statins: these can lower LDL by 50% or more.
Now, here is where things can get a bit confusing. A statin can fall into more than one intensity category depending on the dose prescribed. For example, pravastatin (Pravachol) could be either a low intensity (10 mg and 20 mg doses) or moderate intensity (40 mg and 80 mg doses) statin.
What types of high intensity statins are available?
Currently, there are only a few high intensity statins available in the U.S.:
- Atorvastatin (Lipitor) 40 mg
- Atorvastatin (Lipitor) 80 mg
- Rosuvastatin (Crestor) 20 mg
- Rosuvastatin (Crestor) 40 mg
Lower doses of atorvastatin and rosuvastatin are considered moderate intensity statins.
Who could benefit the most from high intensity statins?
High intensity statins aren’t meant for everyone. Currently, experts recommend high intensity statins for four groups of people:
- Those who have athersclerotic cardiovascular disease (ASCVD) and are age 75 or younger. ASCVD refers to conditions caused by the buildup of plaque (fatty deposits) in the blood vessels. ASCVD can include conditions like heart disease, peripheral artery disease, and stroke.
- Those who have a LDL of 190 mg/dL or higher. LDL higher than this greatly raises your risk for heart problems.
- Those who have diabetes, are between the ages of 40 and 75 years old, have an LDL of at least 70 mg/dL, and have a high chance of developing ASCVD complications in the next 10 years.
- Those who are between the ages of 40 and 75, have an LDL between 70 mg/dL and 189 mg/dL, and have a high risk of developing ASCVD complications in the next 10 years.
Keep in mind these are situations where a high intensity statin could be used. But everyone’s situation is unique. Your healthcare provider may decide a high intensity statin isn’t right for you based on your medical or prescription history. You can always ask your healthcare provider for more information about why they prescribed a certain statin (or any medication!) for you.
Nonetheless, you may also need a high-dose statin for other reasons that go beyond what is listed here if your healthcare provider thinks it’s important for you.
Would high intensity statins be used for anyone else?
Yes. If you’ve been taking a low or moderate intensity statin and your LDL is still too high, your healthcare provider may adjust your cholesterol medication. It’s quite possible that this medication change could include starting a high intensity statin.
What side effects and risks are associated with high intensity statins?
For most people, statins are safe to take and well tolerated. But as with all medications, they have possible side effects and risks to be aware of.
Muscle pain and weakness
The most well-known statin side effect is muscle pain or weakness. Up to 10% of people experience these reversible muscle troubles while taking a statin. However, a serious muscle problem called rhabdomyolysis (muscle breakdown into the bloodstream) is very rare. This serious side effect happens to 0.1% of people (that’s 1 in every 1,000) taking statins.
If you experience any muscle pain or weakness while taking a statin, discuss it with your healthcare provider before stopping your medication. Some people find that only certain statins cause muscle pain. Switching statins may get rid of this side effect.
Type 2 diabetes
Another possible risk with high intensity statins is that they can raise the risk of Type 2 diabetes. In studies, this side effect happened in people who already had a higher risk for developing diabetes. Your healthcare provider should be watching for this side effect by checking your blood sugar when they order other cholesterol-related blood tests. But if you notice any early warning signs of diabetes, like excessive thirst or urination, reach out to your healthcare provider so they can check for the condition.
Though very rarely, high intensity statins can affect liver health. Liver issues happen to about 1% of people taking statins. For most people who have liver side effects, they experience changes to liver blood tests but have no symptoms of liver problems. Liver damage is much rarer, happening to about 1 in every 100,000 people taking statins. Be sure to go for all recommended blood tests, as these can help your healthcare provider catch this side effect sooner.
Is there anyone who shouldn’t take high intensity statins?
There are a few groups of people who shouldn’t take any statin, including high intensity statins:
- Pregnant women
- Nursing women
- People with liver failure caused by cirrhosis
- People who have a known allergy to statins
If you’re concerned about whether a statin is right for you, discuss this with your healthcare provider.
Are there any alternatives to high intensity statins?
There are alternatives available for lowering cholesterol. If you can’t tolerate high intensity statins due to side effects, your provider may lower your dose or switch you to another statin. This means you may be moved from high intensity to moderate or low intensity. Keep in mind the value of lower intensity statins in preventing heart problems is still very good. For most people, it’s better to be on a lower intensity statin than not on anything.
But what if you can’t take any statins? There are several other cholesterol-lowering medications available. This includes PCSK9 inhibitors, a newer type of cholesterol medication that’s injected. PCSK9 inhibitors lower LDL as much as or more than statins, but they’re more expensive and not considered a first choice by experts at this time.
If you’re having any troubles or side effects with your high intensity statin, talk to your healthcare provider. They’ll help find the right alternative for you.
The bottom line
High intensity statins are highly valuable to help lower the risk of heart complications in some people. Higher doses of atorvastatin and rosuvastatin are the currently available high intensity statins. High intensity statins do have some risks and side effects, such as muscle pain. But your healthcare provider can help find an alternative if you’re having trouble taking your statin.
American College of Cardiology. (n.d.). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.
American Heart Association. (n.d.). Join us for the ASCVD patient journey.
American Heart Association. (2018). Safety of statins emphasized in new report.
American Heart Association. (2020). Cholesterol medications.
Bansal, A. B., et al. (2021). HMG-CoA reductase inhibitors. StatPearls.
Centers for Disease Control and Prevention. (2014). Prescription cholesterol-lowering medication use in adults aged 40 and over: United States, 2003–2012.
Chou, R., et al. (2016). Table 1, statin dosing and ACC/AHA classification of intensity. Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force.
Feingold, K. R. (2021). Cholesterol lowering drugs. Endotext.
Grundy, S. M., et al. (2018). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation.
Million Hearts. (2021). Cholesterol management.
National Library of Medicine. (2020). LDL: the “bad” cholesterol.
National Library of Medicine. (2022). Rhabdomyolysis.
Newman, C. B., et al. (2018). Statin safety and associated adverse events: a scientific statement from the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology.
Stone, N. J., et al. (2013). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation.
Zhao, Z., et al. (2019). Comparative efficacy and safety of lipid-lowering agents in patients with hypercholesterolemia. Medicine.
Written by Timothy Aungst, PharmD | Reviewed by Joshua Murdock, PharmD