From the Guidelines
You should not stop taking your statin without consulting your healthcare provider first, as the decision to continue or discontinue statin therapy depends on your overall cardiovascular risk profile, not just your current lipid levels. While your LDL level of 74 mg/dL is below the typical target of 100 mg/dL, and your HDL of 74 mg/dL is excellent (above 50 mg/dL is considered protective for women), statins provide benefits beyond cholesterol reduction, including anti-inflammatory effects and plaque stabilization 1. Your total cholesterol of 175 mg/dL is within normal range, but the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol recommends considering a patient's 10-year ASCVD risk and other risk factors when deciding whether to initiate or continue statin therapy 1.
According to the guideline, in adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL, at a 10-year ASCVD risk of ≥7.5%, starting a moderate-intensity statin is recommended if a discussion of treatment options favors statin therapy 1. Additionally, the guideline suggests that risk-enhancing factors, such as family history of premature ASCVD, persistently elevated LDL-C levels, and chronic kidney disease, may favor initiation of statin therapy 1.
Given your age and lipid profile, it is likely that you have a moderate to high 10-year ASCVD risk, and therefore, continuing statin therapy may be beneficial in reducing your risk of cardiovascular events. However, the decision to continue or discontinue statin therapy should be made in consultation with your healthcare provider, who can assess your individual risk factors and medical history. If you're concerned about continuing the medication, discuss your specific situation with your doctor, who might consider a lower dose or different statin if you're experiencing side effects, rather than complete discontinuation 1.
From the Research
Statin Discontinuation Considerations
- The decision to stop statin therapy should be carefully considered, as discontinuation has been associated with increased risk of myocardial infarction and cardiovascular death 2.
- Studies have shown that discontinuing statins, particularly after acute events, can have harmful effects on cardiovascular outcomes and all-cause mortality 3, 4.
- The beneficial effects of statins in decreasing inflammatory markers, cardiovascular events, cardiovascular mortality, and all-cause mortality have been well established 3, 2.
Patient-Specific Factors
- The patient's age (56 years) and LDL level (74) are important factors to consider when deciding whether to stop statin therapy.
- However, there is no clear evidence to suggest that stopping statin therapy is beneficial for patients with LDL levels below a certain threshold 2, 4.
- The patient's HDL level (74) is also an important factor, but the decision to stop statin therapy should be based on a comprehensive assessment of cardiovascular risk factors 5.
Guideline Recommendations
- Current guidelines recommend continuing statin therapy in patients with a history of cardiovascular disease or those at high risk of cardiovascular events, unless contraindicated 3, 2.
- The American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease risk to guide statin therapy for primary prevention 5.
- Patients should be counseled to adhere to their statin therapy, and clinicians should be aware of the potential harmful effects of statin discontinuation 3, 4.