"Do I have to take statins for the rest of my life?" — A cardiologist answers honestly

This is one of the questions I am asked most often in the clinic.

"Do I have to keep taking statins forever?"

Based on the latest guidelines, I will share the honest reality from the front lines.

Why you cannot stop

As I wrote in my previous article, atherosclerosis is acumulative disease.

The moment you stop taking statins, your LDL-C will return to its original level.

The reason your numbers are improving is because the medication is working, not because you are cured. The damage to your blood vessels continues to accumulate quietly.

What is your target level? — 2025 Latest Edition

In 2025, a working group of the Japan Atherosclerosis Society, in line with ESC and AHA guidelines, announced recommendations to significantly lower LDL-C target levels.

For those who have not yet had heart disease or a stroke (primary prevention)

👤 Low risk | Young and no other risk factors
→ Target: Below 160 mg/dL

👤 Moderate risk | Hypertension or elderly, etc.
→ Target: Below 140 mg/dL

👤 High risk | Diabetes, chronic kidney disease, or smoker
→ Target: Below 120 mg/dL

👤 Very high risk | Diabetes with organ damage, or familial hypercholesterolemia
→ Target: Below 100 mg/dL

For those who have already had heart disease or a stroke (secondary prevention)

❤️‍🔥 Acute coronary syndrome (myocardial infarction, unstable angina, within 1 year of onset)
→ Target: Below 55 mg/dL

❤️ Chronic coronary syndrome (more than 1 year after myocardial infarction)
→ Target: Below 70 mg/dL (Below 55 for ultra-high risk patients)

🧠 Stroke/Peripheral artery disease
→ Target: Below 70 mg/dL

🧬 Familial hypercholesterolemia + cardiovascular disease
→ Target: Below 55 mg/dL

Side effects—these are the only ones you really need to watch out for

① Muscle pain/fatigue (approx. 5–10%)
Most cases are mild and can be managed by changing or reducing the medication. If you are concerned, consult your doctor immediately.

② Rhabdomyolysis (approx. 0.001%)—a rare but serious side effect that cardiologists monitor

This is a serious condition where muscle cells break down in large quantities, potentially leading to kidney failure. While the frequency is extremely low, it is dangerous if overlooked.

🚨 Seek medical attention immediately if you see these signs
→ Severe muscle pain + cola-colored urine

Situations requiring special caution:

• Concomitant use with fibrates (another type of lipid medication)

• Concomitant use with antifungal drugs or immunosuppressants

• Cases where kidney or liver function is impaired

For those who absolutely cannot take them—the option of PCSK9 inhibitors

For those who cannot continue statins due to side effects, or who do not reach their target levels even at the maximum dose, there is an option called PCSK9 inhibitors.

These are injectable drugs that powerfully lower LDL-C by increasing LDL receptors in the liver.

💉 Repatha (evolocumab)
・Administration: Subcutaneous injection every 2 weeks or once a month
・Evidence: Reduced cardiovascular events by 15% in the FOURIER trial (published in NEJM 2017)

💉 Leqvio (inclisiran)
・Administration: Twice a year subcutaneous injection (less burden of clinic visits)
・Lowers LDL-C by approximately 50%. Evidence for cardiovascular events is currently being studied in ongoing trials

Summary

✅ If you stop statins, your LDL-C will return to previous levels immediately. Arteriosclerosis is a cumulative disease
✅ Under the 2025 new recommendations, target levels for those with a history of heart disease are stricter (less than 55–70)
✅ Rhabdomyolysis is extremely rare at 0.001%. Seek immediate medical attention for muscle pain + cola-colored urine
✅ If you cannot take them, consider PCSK9 inhibitors (including the twice-a-year injection option)

Please think of it as: "Good numbers = the medication is protecting you." Do not stop on your own; always consult your primary physician.

📌 Click here for the previous article
Don't judge LDL-C by "normal values" alone. Think of myocardial infarction as an "accumulation" in the blood vessels

• Rhabdomyolysis is extremely rare at 0.001%. Seek immediate medical attention for muscle pain + cola-colored urine

• If you cannot take them, there are PCSK9 inhibitors (including options for injections twice a year)

Please think of it as "good numbers mean the medication is protecting you." Do not stop on your own; always consult with your primary physician.