If my hyperlipidemia is under control, should I stop taking statins (HMG-CoA reductase inhibitors)?

No, Do Not Stop Taking Your Statin When Cholesterol is Under Control

Statins should be continued indefinitely once started for cardiovascular risk reduction, regardless of whether your cholesterol levels have reached target goals. The benefit of statins comes from their ongoing protective effects against heart attacks and strokes, not just from lowering cholesterol numbers 1.

Why Statins Must Be Continued

Statins Work Through Sustained Risk Reduction

• Statin therapy reduces cardiovascular mortality and events through continuous plaque stabilization and anti-inflammatory effects that extend beyond simple cholesterol lowering 1, 2
• The cardiovascular benefit is linearly related to LDL cholesterol reduction without a lower threshold, meaning ongoing therapy continues to provide protection 1
• Meta-analyses demonstrate a 9% reduction in all-cause mortality and 13% reduction in vascular mortality for each 39 mg/dL reduction in LDL cholesterol maintained over time 1

Evidence Against Dose Reduction or Discontinuation

• Research specifically shows that reducing statin dosage after achieving target LDL cholesterol results in significantly higher follow-up LDL-C levels and fewer patients maintaining goal levels 3
• The American College of Cardiology explicitly recommends that statins should not be permanently discontinued in patients with established atherosclerotic cardiovascular disease 4
• Patients who discontinue statins without medical advice significantly increase their risk for cardiovascular events 5

Monitoring While Continuing Therapy

Appropriate Follow-Up Schedule

• Obtain lipid profiles 4-12 weeks after statin initiation or dose changes, then annually thereafter to monitor medication adherence and efficacy 1
• Annual monitoring increases the likelihood of dose titration and following the treatment plan 1
• Continue monitoring even when at goal to ensure sustained control and medication compliance 1

Special Circumstances Where Adjustment May Be Considered

Limited Exceptions to Continuation

• Only absolute contraindications or significant adverse effects warrant statin adjustment or discontinuation 3
• In adults >75 years with functional decline, multimorbidity, frailty, or reduced life expectancy, stopping statins may be reasonable after risk-benefit discussion 1
• Temporary discontinuation is required during pregnancy (stop 1-2 months before attempting conception or immediately when pregnancy discovered) 1
• For patients on dialysis not previously taking statins, initiation is not recommended, though continuation may be reasonable if already established 1

Managing Side Effects Without Stopping

• If muscle symptoms occur, attempt dose reduction, switch to a different statin, or try alternate-day regimens rather than complete discontinuation 5
• Evidence supports benefit from even extremely low, less-than-daily statin doses in patients with intolerance 1
• The difference in muscle symptoms between statin and placebo in randomized trials is <1%, suggesting most symptoms are not pharmacologically caused 2

The Critical Pitfall to Avoid

The most common and dangerous mistake is reducing or stopping statins once cholesterol goals are achieved. This practice is clinically observed but contradicts evidence-based medicine 3. Your cholesterol will likely rise again, but more importantly, you lose the ongoing cardiovascular protection that statins provide beyond cholesterol lowering 1, 2. The maximum tolerated statin dose should be maintained for optimal cardiovascular risk reduction 1.