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To Statin or Not to Statin?

  • Writer: Brenda Borton, NP
    Brenda Borton, NP
  • Jul 30
  • 4 min read

Updated: Aug 5

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This is the question, and whether or not they even prevent cardiovascular incidents is also a source of concern and confusion. Patients and physicians are worried about the side effects and long-term effects of statin therapy.


In this post, I examine the guidelines of statin therapy, how lifestyle management can effectively lower LDL cholesterol, potential side effects of using a statin and risk factors as well as a few dietary supplements that can help you lower LDL cholesterol.


One source of confusion is that there are many differing recommendations from a variety of respected groups.


The 2025 guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend high-intensity statin therapy for all patients with acute coronary syndromes (ACS).


Understanding the Guidelines


One source of confusion is that there are many differing recommendations from a variety of respected groups.


The 2025 guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend high-intensity statin therapy for all patients with acute coronary syndromes (ACS).


What is acute coronary syndrome?


In essence it means that the heart is not getting enough oxygen due to a decrease in blood flow. The decrease in blood flow can be from a blockage, unstable angina or even a heart attack, these situations all require immediate medical attention.


You may be thinking ‘that won’t happen to me, I am healthy!’Unfortunately, as we get older, the odds are not in our favor. Without targeted testing to be sure that our bodies are functioning within healthy guidelines, it is just wishful thinking.


Assessing Your Risk


We also need to address primary prevention—how can we prevent acute coronary syndrome and cardiovascular diseases? The prevention of disease and the maintenance of health and well-being is what we are about at Miller Functional Medicine!


The first step is to figure out what is your risk of developing atherosclerotic cardiovascular disease (ASCVD), or atherosclerosis for short.


What is atherosclerosis?


It’s a condition caused by the buildup of plaque in the arteries, leading to reduced blood flow and potentially serious health problems like a heart attack.


ASCVD encompasses a range of conditions including:

  • Coronary heart disease (heart attacks, angina)

  • Cerebrovascular disease (strokes)

  • Peripheral artery disease (reduced blood flow to limbs, pain, or clots)


Statin Therapy Recommendations


High-risk group: If LDL-C is greater than 190, high-intensity statin therapy is typically the first line of treatment, even without calculating 10-year risk.


Other risk-enhancing factors include:

  • Family history

  • Metabolic Syndrome

  • Chronic Kidney Disease (CKD)

  • Inflammatory conditions


Many practitioners begin statins at lower thresholds, often if calculated LDL-C is >99. However, in Functional Medicine, we look beyond the number.


LDL is a building block for all steroid hormones, especially cortisol. So high LDL may also indicate increased stress.


We always encourage shared decision-making: have a detailed conversation with your provider about whether statin therapy is right for you.


Non-Statin Options & Functional Medicine Perspective


Non-statin medications include:

  • Ezetimibe

  • PCSK9 inhibitors (Repatha, Praluent)


Boston Heart Labs offers testing to assess cholesterol absorption/synthesis. This supports a more personalized treatment plan.


We also go further with advanced lipid testing like the NMR Lipid Profile, which breaks down LDL particle size and quality.


Lifestyle Strategies That Lower LDL



Lifestyle changes can significantly impact LDL levels and overall heart health:


Dietary changes:

  • Reduce saturated and trans fats

  • Increase soluble fiber (oats, beans, lentils, fruits)

  • Add plant sterols/stanols

  • Follow heart-healthy diets (Mediterranean, DASH, plant-based)


Physical activity:

  • 150+ minutes of moderate exercise weekly


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Weight management & smoking cessation


Alcohol intake:

  • Moderate consumption recommended


Mindfulness-Based Stress Reduction (MBSR):

  • Practices such as meditation, Insight Timer, or recommended books like “Full Catastrophe Living” by Jon Kabat-Zinnto two drinks per day for men), as excessive alcohol intake can negatively affect lipid levels[6][8].

 

Statin Risks and Side Effects


Common concerns include:

  • Muscle pain or weakness

  • Increased risk of type 2 diabetes

  • Liver enzyme changes

  • Rare kidney injury

  • Possible memory issues (inconclusive evidence)


Risk factors for side effects:

  • Advanced age

  • Female sex

  • Kidney/liver impairment

  • High statin dose or strength


Effective Supplements for LDL Reduction

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In Functional Medicine, supplements are carefully selected and tested. We may recommend:

  • Red Yeast Rice (monacolin K): Lowers LDL 15–25%—acts like a statin and requires CoQ10

  • Phytosterols/Stanols: Reduce LDL 5–15%

  • Soluble Fiber: Oats, psyllium, legumes

  • Berberine: Up to 25% LDL reduction

  • Coenzyme Q10: To support statin tolerance


Supplements should always be guided by a provider. At Miller Functional Medicine, we offer consultations and tailored supplement bundles, including a Basic Lipid Support pack.


Browse Miller Functional Medicine's Basic Lipid Support Pack on Fullscript


In Summary


I hope this review has helped you understand the various aspects of statin therapy, lifestyle changes, and supplement options.


Remember: your body needs LDL to make essential hormones. Our goal is balance—not elimination. With the right mix of lifestyle, functional testing, and sometimes targeted medication, you can take a proactive step toward vibrant cardiovascular health.


If you’re interested in learning more, book a consultation with me (available in Alpharetta and Blairsville) or Dr. Miller.


Book a consultation with Brenda Borton, NP or Dr. Karen Miller to explore your options and take the next step toward optimal health!


In good health,

Brenda Borton, NP

 

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