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Education Center — 8 minutes

Statins, cholesterol, and personalized medicine: Balancing the good and the bad for better heart health

August 20, 2025

Michel Cameron, PhD
Michel Cameron, PhD
Associate Director, Pharmacogenomics, Medical Science Liaison
LinkedIn

For almost a century, we have known that high levels cholesterol can be detrimental to your heart’s health. Indeed, the link between elevated cholesterol and heart attacks was first established in the late 1930s through genetic studies by a Norwegian physician, Carl Müller. [1] However, it’s not all bad with cholesterol as it is found in two different forms, each having profoundly different health impacts. LDL (low-density lipoprotein) cholesterol, sometimes called “bad” cholesterol makes up most of your body’s cholesterol. High levels of LDL increase the risk for heart disease and stroke. [2] The other form of cholesterol, HDL (high-density lipoprotein) cholesterol, is the “good” cholesterol, which lowers your risk of heart disease, stroke, as data suggests, may also reduce your risk of developing other health problems, such as cancer [3].

cardiovascular-health

Currently, heart disease is a major health issue as it effects about 1 in 12 adults aged 20 and over in Canada (Public Health Agency of Canada, as of February 2021). While cholesterol is not the only culprit, other known factors that are strongly linked to an increased risk of heart disease include sedentarism, smoking, alcohol consumption, and unhealthy diet, it remains an element that can be easily acted upon due to the availability of effective medications that reduce LDL blood levels. Statins, which were first used in the 80s, are a relatively safe class of medications that effectively reduces LDL cholesterol. A reduction in LDL cholesterol blood levels (statins generally lower levels by 30% to 50%) is associated with a 20% to 25% decrease in the risk of cardiovascular events; overall, they can reduce all-cause mortality by 12%. [4,5]

Who are statins for?

Statins are primarily prescribed to individuals at risk of cardiovascular disease:

  • those with high cholesterol,
  • a history of heart attack or stroke, diabetes,
  • other risk factors, such as diabetes, family history, high blood pressure, smoking.

Of course, statins are not a replacement for a healthy lifestyle, which will significantly improve your heart health and enhance the effectiveness of these medications, but still, not bad for a mostly innocuous pill that about 10% of Canadian adults take every day (Statistics Canada). So, what’s the catch?

Statin side effects

While most individuals that take them have no complaints, about 5% to 25% of patients experience side effects, with muscle pain being the most common complaint. Unfortunately, the discomfort can be bothersome enough for patients to stop taking their statin, raising their risk of heart disease back to previous levels. [6,7]

The most common type of muscle pain is called myalgia, described as a “flu-like” muscle discomfort, such as pain, aches, stiffness, cramps during or shortly after exercise. Much rarer is myopathy, affecting 1/1000 patients on statins, which presents as muscle weakness independent of pain. Another even less common type of muscle symptom is rhabdomyolysis, a severe side effect seen in only 1/10,000 patients. It translates to muscle injury where your muscles break down. As with any treatment, measuring the risks and benefits is an essential part of decision-making. Often, the benefits of statin therapy far outweigh the risks but sometimes, muscle pain is enough to cease therapy altogether, adding strain to the patient-doctor relationship.

In any case, it is crucial to talk to your doctor if muscle pain occurs. Sometimes, statins are not even the cause of muscle pain. Your physician can try to adjust your dose or prescribe a different statin or another cholesterol medication that is also effective. While this usual trial-and-error approach to finding a well-tolerated and effective statin therapy, genetics can be a powerful tool to guide your doctor toward low-risk options.

Using precision medicine to guide your statin therapy

Lately, a branch of precision medicine, called pharmacogenomics (PGx), has been gaining momentum in various clinical settings, such as psychiatry, oncology, pain management and cardiology. This science is built upon the fact that our own unique genetic code can makes us react differently to the same medication. In the case of statins, a standard dose that works fine for most people can be too high for some that have a specific genetic variant. Specifically, the 5 variant of the SLCO1B1 gene increases the blood level of statins, causing them to become too high, resulting in muscle symptoms. [8] By doing a pharmacogenomic test, a patient can find out whether they carry the 5 variant, which helps their doctor choose an appropriate statin and dose. With 7 different statins to choose from, it can be helpful to genetically guide the choice and dose of statin, identifying which therapy has the lowest risk of causing muscles symptoms.

While knowledge of your SLCO1B1 gene alone does not guarantee that patients taking statins will be free from muscle-related side effects, it does present an opportunity to more accurately identify individuals at increased risk and provide reassurance to those who are not. Recent data shows that not only does using a PGx test to guide statin therapy improve treatment adherence and reduces statin-associated muscle symptoms, it is reassuring that research has demonstrated an absence of negative effects on cardiovascular disease prevention. [9,10]

Adopting a pro-active approach to your health

With the constant influx of new information, it can be difficult to make sense of everything we receive daily. However, the principal than an ounce of prevention is worth a pound of cure has stood the test of time. Eating well and staying physically active have long been considered excellent ways to support long-term well-being, and their effectiveness in disease prevention and maintaining good health is now scientifically proven. [11,12] In that same spirit of prevention, statins remain a powerful tool to lower the risk of cardiovascular disease—but side effects like muscle pain can lead some patients to stop treatment, raising their risk once again. This is where pharmacogenomics can help guide personalized statin therapy, reduce side effects, and promote better long-term treatment adherence.

Sources12
  1. Müller C. Xanthomata, hypercholesterolemia, angina pectoris. Acta Med Scand 1938;89:75–84.
  2. Stanciulescu LA, Scafa-Udriste A, Dorobantu M. Exploring the Association between Low-Density Lipoprotein Subfractions and Major Adverse Cardiovascular Outcomes-A Comprehensive Review. Int J Mol Sci 2023;24.
  3. Jafri H, Alsheikh-Ali AA, Karas RH. Baseline and on-treatment high-density lipoprotein cholesterol and the risk of cancer in randomized controlled trials of lipid-altering therapy. J Am Coll Cardiol 2010;55:2846-54.
  4. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78.
  5. Cholesterol Treatment Trialists C, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670-81.
  6. Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA, The National Lipid Association's Muscle Safety Expert P. An assessment by the Statin Muscle Safety Task Force: 2014 update. J Clin Lipidol 2014;8:S58-71.
  7. Zhang H, Plutzky J, Shubina M, Turchin A. Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. Ann Intern Med 2017;167:221-7.
  8. Cooper-DeHoff RM, Niemi M, Ramsey LB, et al. The Clinical Pharmacogenetics Implementation Consortium Guideline for SLCO1B1, ABCG2, and CYP2C9 genotypes and Statin-Associated Musculoskeletal Symptoms. Clin Pharmacol Ther 2022;111:1007-21.
  9. Peyser B, Perry EP, Singh K, et al. Effects of Delivering SLCO1B1 Pharmacogenetic Information in Randomized Trial and Observational Settings. Circ Genom Precis Med 2018;11:e002228.
  10. Vassy JL, Gaziano JM, Green RC, et al. Effect of Pharmacogenetic Testing for Statin Myopathy Risk vs Usual Care on Blood Cholesterol: A Randomized Clinical Trial. JAMA Netw Open 2020;3:e2027092.
  11. Patterson R, McNamara E, Tainio M, et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol 2018;33:811-29.
  12. Katzmarzyk PT, Powell KE, Jakicic JM, et al. Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee. Med Sci Sports Exerc 2019;51:1227-41.
Michel Cameron, PhD
Michel Cameron, PhD
Associate Director, Pharmacogenomics, Medical Science Liaison
LinkedIn
Seeking to make the science of genetics accessible for everyone, in 2014 Michel Cameron co-founded BiogeniQ, a company specialized in genetics, where he directed the design and development of pharmacogenomics tests. Today this company is owned by Biron. Michel Cameron holds a Ph.D. in pharmacology from the Université de Montréal and completed postdoctoral studies in pharmacogenomics at the Montreal Heart Institute’s Pharmacogenomics Centre.