And the Mayo Clinic’s own data quietly proves it
Statins are often presented as a no-brainer. Elevated cholesterol equals prescription. End of discussion.
Except that’s not how risk works.
And it’s not how the math works either.
At James Clinic, we don’t argue about statins emotionally. We look at actual risk reduction, not marketing slogans disguised as guidelines. And one of the clearest windows into that reality is the Mayo Clinic Statin Decision Aid.
Once you see the numbers, it’s hard to unsee them.
The Data That Rarely Gets Explained
Relative risk reduction is not the same as benefit
You’ll often hear statins reduce heart attack risk by 20–30%. That sounds impressive. It’s also incomplete.
That number reflects relative risk reduction, not absolute risk reduction. And those are very different things.
Let’s slow this down.
If your 10-year risk of a heart attack is 10%:
- About 10 out of 100 people will have an event
- A statin might reduce that to about 7–8 out of 100
That’s a 2–3% absolute risk reduction over 10 years.
Put plainly:
- 97–98 people took the medication for a decade
- And saw no difference in whether they had a heart attack
That doesn’t mean statins never help.
It means their benefit is modest and highly dependent on baseline risk.
Number Needed to Treat: The Quiet Metric No One Mentions
The Mayo Statin Decision Tool makes this unavoidable:
- The number needed to treat (NNT) to prevent one cardiovascular event is often 40–100 people
- Treated for 10 years
- Depending on starting risk
This is where the conversation should happen.
Instead, it usually ends with “your LDL is high.”
That’s not shared decision-making. That’s protocol medicine.
Now Let’s Talk About Side Effects
Because “rare” is meaningless when it’s you
Statins are generally safe.
They are not consequence-free.
Documented and commonly reported effects include:
Muscle and Performance Effects
- Myalgias and weakness
- Reduced exercise tolerance
- Mitochondrial energy disruption
- Disproportionate impact on athletes and active patients
Metabolic Effects
- Increased insulin resistance
- Higher rates of new-onset diabetes, particularly in women and those already metabolically stressed
Cognitive Complaints
- Brain fog and memory issues in a subset of patients
- Often dismissed, yet frequently reproducible when the drug is stopped and restarted
Nutrient Depletion
- Reduced CoQ10 levels
- Downstream effects on muscle and cardiac energy production
None of this means statins should never be used.
It means pretending these effects don’t matter is intellectually dishonest.
The Most Controversial Part
Statins treat cholesterol numbers, not cardiovascular health
Statins lower LDL. That’s true.
Lower LDL does not automatically equal lower risk for every patient.
They do not:
- Fix insulin resistance
- Reduce chronic inflammation
- Repair endothelial dysfunction
- Address sleep deprivation or stress physiology
- Correct thyroid or hormone imbalances
In many patients, those factors drive risk far more than cholesterol alone.
So when statins are prescribed without addressing these upstream issues, we shouldn’t be surprised when outcomes disappoint.
How We Actually Decide at James Clinic
We don’t ask:
“Does this lab value qualify for a statin?”
We ask:
“Is this patient likely to meaningfully benefit, and is this the best first move?”
That decision depends on:
- Absolute cardiovascular risk
- LDL particle burden and ApoB
- Metabolic health and insulin resistance
- Inflammation
- Imaging when appropriate
- Lifestyle capacity and patient goals
Sometimes the answer is yes, a statin makes sense.
Sometimes the answer is not yet.
Sometimes the answer is no.
That’s not rebellion. That’s precision.
If you were told you “need a statin” without a discussion of:
- Absolute risk reduction
- Number needed to treat
- Side effects and trade-offs
- Alternatives and upstream drivers of risk
Then you weren’t given a choice. You were given an order.
At James Clinic, we believe patients deserve better than that.
If you want a cardiovascular plan built on math, physiology, and individualized risk, not fear and algorithms, it’s time for a deeper conversation.
Statins are a tool.
They are not a strategy.
And your heart deserves a strategy.