Statins, a class of drugs used to lower blood cholesterol, are being touted as one of the wonder drugs of the 21st century. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques on your artery walls, helping prevent further blockage in your blood vessels. Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others.

Already shown to be effective in lowering cholesterol, statins may have other potential benefits researchers are finding. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What happens when you take a statin for decades? Can they help prevent other disease?

With frequent news reports and studies on statins, making sense of it all can be a challenge. There is a lot to know, but you can begin to put the available information into perspective to help you better determine if statins might be right for you.

The cholesterol-lowering effects of statins are well documented. Research shows that these drugs block a substance in your liver needed to make cholesterol. Statins also help your body reabsorb cholesterol that has accumulated on your artery walls. Together, these effects significantly reduce the risk of heart attacks and strokes.

Whether you need to be on a statin depends on your cholesterol level along with your other risk factors for cardiovascular disease. If you have high cholesterol, the numbers alone won't tell you or your doctor the whole story. The decision to start a statin drug depends, in part, on how high your cholesterol is and what your individual cardiovascular risk is over the next 10 years.

High cholesterol is only one of a number of risk factors for heart attack and stroke. Your cholesterol level is considered along with other factors including:

• Family history
• Lifestyle
• Blood pressure
• Age
• General health
• Presence of diabetes
• Excess weight
• Smoking

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke is probably already low.

Lifestyle changes remain the cornerstone for reducing your risk of heart disease, whether you take a statin or not. Quitting smoking, eating a low-fat, low-cholesterol diet, getting daily activity and managing stress are examples of lifestyle changes that will improve cholesterol, and most all of the other risk factors for heart disease. In fact, lifestyle changes may have a greater impact on reducing risk of heart disease and stroke than does medication alone.

If you're following the recommended lifestyle behaviors but your cholesterol — particularly your low-density lipoprotein (LDL), or "bad" cholesterol — remains high, and you have other risk factors for heart disease, you and your doctor may want to consider a prescription medication such as a statin. Risk factors for heart disease and stroke are:

• High cholesterol
• High blood pressure
• Diabetes
• Excess weight
• Family history of heart disease
• Physical inactivity
• Heavy alcohol use
• Poor stress and anger management
• Age
• Smoking

You may think that once your cholesterol goes down, you can stop taking medication. But, if your cholesterol levels have decreased as a result of taking a statin, you'll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.

The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may allow you to maintain low cholesterol without continuing to take the medication, but do so under your doctor's supervision.

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication. Side effects include:

• Muscle and joint aches (most common)
• Nausea
• Diarrhea
• Constipation

There are two potentially serious side effects of statins of which you need to be aware:

• Liver damage.Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. If the increase is severe, you may need to stop taking it, which usually reverses the problem. If left unchecked, increased liver enzymes potentially can cause permanent liver damage. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin, increase the risk of liver problems even more in people who take statins. Because liver problems may develop without symptoms, people who take statins have their liver function tested periodically.
• Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can impair kidney function and lead to kidney failure. Certain drugs when taken with statins can increase the risk of rhabdomyolysis. These include gemfibrozil, erythromycin (Erythrocin), antifungal medications, nefazodone (Serzone), cyclosporine and niacin. If you take statins and have new muscle aching or tenderness, consult with your doctor.

It's important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver disease. Also, check out whether statins interact with any other prescription or over-the-counter drugs or supplements you take.

Statins effectively reduce bad cholesterol (LDL). But, some people have other cholesterol traits that may benefit from a different type or combinations of medication. For example:

• If you are not able to lower your LDL to the desired goal using statin medication, your doctor may add ezetimibe (Zetia) to your treatment plan. This combination will help drop your LDL level further, perhaps even another 15 percent to 20 percent.
• If you have both high LDL and high triglycerides, you may benefit from combining the statin with niacin (Niaspan) or combining the statin with a fibric acid drug such as fenofibrate (TriCor) or gemfibrozil (Lopid). The risk of muscle problems is higher when these medications are paired, so to combat that risk, the dose of statin is lowered.
• If you have just high triglycerides, use of niacin (Niaspan) is very effective. Fibric acid agents (TriCor and Lopid) are another option. Fish oil (omega-3 fatty acid) supplements in 2- to 4-gram doses also can help.
• If your high-density lipoprotein (HDL) cholesterol is low, niacin might be the best choice to raise it. Fibric acids also are useful but less effective than the niacin.

In some cases, one medication may simply not be effective and a different drug must be substituted. For other people, lifestyle changes may be all that are needed to lower cholesterol.

Scientists are just beginning to uncover potential new benefits of statins. So far, some studies appear promising, but many results remain unclear. It's also uncertain how or if high cholesterol itself plays a role in other diseases such as colon cancer and neurological diseases such as dementia.

High cholesterol affects all arteries, not just those in the heart. Its negative effects permeate the body, so it's likely that the benefits of lowering cholesterol might have widespread health benefits as well. It's also likely that statins have additional properties and actions that affect other organ systems — as do many medications (pleiotropic effects).

The most immediately promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart, to blood vessels and organs throughout the body.

In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. Statins also help relax blood vessels, lowering blood pressure. In addition, statins have blood-thinning effects, reducing the risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.

Other benefits of statins include:

• Prevention of arthritis and bone fractures. Statins reduce inflammation in the body and improve blood flow through smaller blood vessels. These actions seem to have a protective effect on the bones and joints.
• Prevention of colon cancer. A May 26, 2005, study found that statins significantly reduced the risk of colon cancer by inhibiting the growth of colon cancer cells.
• Reduction in the risk of dementia and Alzheimer's disease. Statins seem to have a neuroprotective effect. The exact mechanism of this effect is not clear. It may be a direct connection between cholesterol lowering and improved cognitive function. Another theory suggests that statins reduce the occurrence of small, possibly undetected strokes, the damage from which would normally accumulate over time causing dementia.
• Protection of the kidneys. Statins may help protect kidneys, through their effects on cholesterol and blood pressure and perhaps their ability to reduce inflammation.

Statins may also be helpful in controlling the body's immune system response after an organ transplant.

When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

• Do I have other risk factors for cardiovascular disease?
• Am I willing and able to make lifestyle changes to improve my health?
• Am I concerned about taking a pill everyday, perhaps for the rest of my life?
• Am I concerned about statins' side effects or interactions with other drugs?
• Am I worried about having a heart attack or stroke?

It's important to take into account not only your medical reasons for a decision, but also your personal values and concerns. Talk to your doctor about your total risk of cardiovascular disease and discuss how your lifestyle and preferences play a role in your decision about taking medication for high cholesterol.