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The main side effects of statins are muscle pain and brain fog (from some statins -- others cross the blood-brain barrier much less).

The benefit of statins is to not only lower LDL cholesterol, but also inflammation, which is now actually a stronger risk factor for cardiovascular disease than cholesterol: https://www.empirical.health/blog/inflammation-and-heart-hea...

Layering PCSK9 inhibitors, ezetimibe, and statins can lower ApoB/LDL cholesterol by 85–90%, which would have been unheard of until recently.

On the horizon, drugs in clinical trials lower Lp(a) (the strongest hereditary risk factor for heart disease) by 94%. Currently, there are four RNA-based drugs in trials that effectively silence the gene that makes Lp(a) in liver cells: lepodisiran, olpasiran, pelacarsen, and zerlasiran.

3 comments

Thanks! I've been looking into this a little recently, so thanks for the very timely article and advice.

Do you have any info on good ways to nail down personal sources of inflammation relevant to cardio health, or do you think that just general anti-inflammatory diet/habits is the best we can do right now? We were hunting down a source of mold in our house recently due to some blood markers recently, which got me thinking about inflammation sources and cardio health (we found a big patch of mold between our floors and removed it, blood markers immediately improved).

I had the brain fog. I switched from atorvastatin (dizziness) to pravachol (no dizziness), and then again to higher effective dosage of rosuvastatin (still no dizziness). I went from LDL 152 to LDL 83.

But I have high Lp(a) and so I'm prescribed a baby aspirin every other day. This counteracts the Lp(a) clotting effect but doesn't fix its genetic cause.

It's a journey.

I was recently prescribed rosuvastatin (my first time taking any statin), and I had some very intense brain fog. How would you describe the feeling of what you experienced? The best way I could describe it to my friends and family was that I felt like I lost a quarter of my IQ and slept only 5 hours every night(I was getting great sleep, it just felt that way).

It was such a strange feeling. It's a weird feeling to know you're brain just isn't working as it has always worked.

I had dizziness from atorvastatin and nothing from Pravachol and Rosuvastatin. The conclusion I draw is that you have to find something that works. But this is uncharted territory. Your docs won't know and you have to kind of force the issue.

> About 10% of people develop muscle aches

> Concerns about statin effects on the brain, such as cognitive impairment or dementia, are unfounded

https://www.health.harvard.edu/heart-health/what-are-the-ris...