Understanding the Hesitation: Why Do Some People Choose Not to Take Statins?

October 11, 2025 •

3 min read

Despite their proven benefits in reducing cardiovascular events, approximately 50% of patients discontinue statin therapy within one year of starting. Understanding why do some people choose not to take statins involves exploring a range of factors including side effects, personal beliefs, and misinformation.

Quick Summary

Patients may decline or discontinue statins due to fear of side effects like muscle pain, a preference for lifestyle changes, medication costs, or general aversion to taking pills. The 'nocebo effect' and misinformation also play significant roles.

Key Points

Side Effects are the Top Concern: The most common reason people refuse or stop statins is the fear or experience of side effects, especially muscle pain.
The Nocebo Effect is Real: Many reported symptoms are not caused by the drug itself but by the negative expectation of harm, a phenomenon known as the nocebo effect.
Lifestyle Preference: A significant number of patients prefer to try lowering cholesterol through diet and exercise before committing to medication.
Medication Aversion and Cost: A general dislike for taking daily pills, concerns about taking too many medications (polypharmacy), and cost are also key factors.
True Intolerance is Uncommon: While many report issues, studies estimate the prevalence of true statin intolerance is only between 6% and 10%.
Alternatives Exist: For patients who cannot tolerate statins, other effective medications like PCSK9 inhibitors, ezetimibe, and bempedoic acid are available.
Patient Beliefs Matter: Individuals who decline statins are often less convinced of their safety and effectiveness, sometimes influenced by online misinformation.

Statins are a class of drugs effective in lowering LDL cholesterol and reducing the risk of heart attacks and strokes. They are a key treatment for high cholesterol and recommended for cardiovascular disease prevention. However, many patients do not take or stop taking them for various reasons, including physical, psychological, and practical concerns.

The Leading Reason: Fear and Experience of Side Effects

A primary reason for declining or stopping statins is the fear or experience of side effects. While generally well-tolerated, some individuals experience adverse effects.

Statin-Associated Muscle Symptoms (SAMS)

Muscle pain (myalgia) is the most frequent complaint, described as soreness, weakness, or tenderness. The perceived risk is higher than the actual risk (around 5% or less compared to placebo). Rarely, more severe muscle damage like myositis or rhabdomyolysis can occur.

Other Potential Side Effects

Other reported side effects include:

Increased Blood Sugar: A small increase may occur, potentially leading to new-onset type 2 diabetes in those at risk, though benefits typically outweigh this risk.
Digestive Issues: Nausea, gas, diarrhea, or constipation are possible.
Neurological Effects: Rare reports of memory loss and confusion exist, usually reversing after stopping the medication. Some studies do not support this link, and some suggest potential benefits for dementia.
Liver Damage: Rare increases in liver enzymes can occur.

The 'Nocebo' Effect: When Expectation Becomes Reality

The "nocebo effect" contributes to reported side effects. This is when negative expectations lead to negative symptoms. One study found that most symptom intensity reported on statins was also present with a placebo. Misinformation online can exaggerate risks, causing patients to attribute common issues to their statin. Addressing this effect helped some patients successfully restart statin therapy.

Personal Beliefs and Preferences

Individual choices are also shaped by personal health views.

Preference for Lifestyle Changes: Many prefer trying diet and exercise first. While crucial, these changes may not be enough for those with very high cholesterol or genetic risk.
Aversion to Medication: Some dislike taking daily pills or are concerned about taking multiple drugs (polypharmacy).
Beliefs About Statin Efficacy and Safety: Those who decline statins are less likely to view them as safe or effective, potentially due to misinformation and lack of provider communication.

Practical Barriers: Cost and Access

Cost can be a barrier despite the availability of generic statins, especially for those with high co-pays or no insurance. Higher co-payments are linked to lower adherence. A review of online posts showed insurance or cost was a common reason for switching or stopping statins.

Statin Alternatives: A Comparison

Alternatives exist for those intolerant to statins or who choose not to take them. Discussing these with a healthcare provider is important due to differences in mechanisms, side effects, and costs.


Medication Class	How It Works	Common Side Effects
Statins	Block cholesterol production in the liver.	Muscle pain, digestive issues, increased blood sugar.
Ezetimibe (Zetia)	Reduces cholesterol absorption in the small intestine.	Stomach pain, diarrhea, fatigue.
PCSK9 Inhibitors	Injectable drugs that help the liver remove more LDL cholesterol from the blood.	Injection site reactions, flu-like symptoms, back pain.
Bempedoic Acid (Nexletol)	Oral non-statin that blocks cholesterol production in the liver.	Gout, elevated liver enzymes, muscle spasms.
Bile Acid Sequestrants	Bind to bile acids in the intestine, forcing the liver to use more cholesterol.	Constipation, heartburn, bloating, nausea.
Fibrates	Primarily lower triglycerides and can raise HDL ("good") cholesterol.	Stomachaches, constipation, headaches, muscle pain.

Conclusion: A Decision Based on Dialogue

The choice regarding statin therapy is personal and involves multiple factors. While side effects are a major concern, the nocebo effect, preference for lifestyle changes, cost, and medication aversion also play roles. True statin intolerance is less common than perceived, estimated around 9-10%, with many perceived side effects not directly caused by the drug. Open communication with healthcare providers is vital to balance the proven cardiovascular benefits of statins against individual concerns and potential risks. Addressing misinformation and exploring alternative strategies can help find suitable cholesterol management for most individuals.

For more information from an authoritative source, you can visit the American Heart Association.

Frequently Asked Questions

The most frequently reported reason for stopping statins is the experience or fear of side effects, with muscle aches and pains (myalgia) being the top complaint.

While many people report side effects, large-scale analyses suggest the prevalence of true statin intolerance is relatively low, estimated to be between 6% and 10% of patients.

The nocebo effect is when a person's negative expectations about a medication cause them to experience adverse symptoms. For statins, studies show that a majority of reported muscle symptoms occur at the same rate when patients are unknowingly taking a placebo (a sugar pill).

Yes, lifestyle changes like a heart-healthy diet and regular exercise can lower cholesterol. If medication is still needed, alternatives to statins include ezetimibe, PCSK9 inhibitors, and bempedoic acid, among others.

The FDA warns of rare reports of memory loss or confusion, which typically resolve after stopping the drug. However, multiple large studies have found no consistent link, and some research even suggests statins may help protect against dementia.

Many people have a preference for non-pharmacological interventions and wish to see if they can manage their cholesterol through lifestyle modifications before starting a daily medication. However, for those at high risk, lifestyle changes alone may not be enough.

Yes, there are different statin medications. If one causes side effects, a doctor might suggest trying a different one or a lower dose. Some research suggests certain statins like pravastatin and rosuvastatin might be less likely to cause muscle pain.