What to Ask Before Your Next Statin Prescription

“Questions for Your Doctor” — fifth in the series

One hundred people take a statin every day for five years. Ninety-nine of them receive no cardiovascular benefit. One avoids a non-fatal heart attack. None of them avoid death.

That is the Number Needed to Treat for primary prevention — the medical term for what happens when you give statins to people who have never had a heart event. It comes from the same published trials that produce the “30% risk reduction” figure your doctor is likely to quote. The 30% is a relative number. The absolute number — the one that describes what will actually happen to you — is approximately 1 in 100 over five years.

Aseem Malhotra, a consultant cardiologist, calculated that taking a statin for a full year after a heart attack adds less than one day to life expectancy. For men without pre-existing heart disease, statins have not been shown to extend life at all. For women at any level of risk, the data are worse: cardiovascular deaths decrease, deaths from other causes increase by a corresponding amount, and total mortality is unchanged. Malcolm Kendrick, who spent decades examining these trials, put it plainly. For everyone except men already suffering from heart disease, statins do not increase life expectancy by one single day.

These numbers are published. They are not contested, even by the drug manufacturers. What is contested is whether patients should be told them before the prescription is written.

New 2026 guidelines from leading cardiology groups now recommend assessing cholesterol risk as early as age 30, with lower treatment thresholds and expanded eligibility. The market for statins — already the most prescribed drug class in history, with cumulative global revenue exceeding $1 trillion — continues to grow.

The statin consultation typically lasts a few minutes. Cholesterol is high. A statin is recommended. The patient agrees. What is almost never discussed: the absolute risk reduction, the side effect rates from populations that were not pre-screened for drug tolerance, the fact that the raw safety data from every major statin trial have been withheld from independent analysis, or the evidence that high cholesterol in people over 60 is associated with living longer, not dying sooner.

The new document — Statin Prescription: Questions for Your Doctor — is the fifth instalment in this series. It contains ten questions, each with a Key Fact and two paragraphs of evidence. Eight questions address the statin itself — absolute versus relative risk, side effects, trial design and funding, the role of cholesterol in the body, treatment thresholds, alternatives, and whether the drug extends life. Two questions address the cholesterol hypothesis the entire prescribing cascade depends on. A routing table directs you to the questions that match your situation. A printable Quick Reference page collects all ten questions and Key Facts on a single sheet to take to your appointment.

Here is one of the ten:

Has it been proven that high cholesterol actually causes heart disease?

Key Fact: The Framingham Heart Study — the longest-running cardiovascular study in history — found that for men over 47, there was no difference in mortality between those with high cholesterol and those with low cholesterol. More than 95% of heart attacks occur after age 48.

The routing works like this. Offered a cholesterol test or told your number is high: Questions 1, 2, 8, and 10. Doctor has recommended a statin: Questions 1, 3, 4, 5, and 10. Already taking one and experiencing side effects: Questions 3, 5, 7, and 10. Considering alternatives: Questions 2, 7, 8, 9, and 10.

The evidence is drawn from Cholesterol and Statins: An Essay on the Most Successful Unfalsifiable Claim in Medicine, which compiles research from Kendrick (The Great Cholesterol Con, The Clot Thickens), Ravnskov (The Cholesterol Myths), Demasi’s BMJ review of statin trial transparency, Sinatra (The Coenzyme Q10 Phenomenon), and Graveline (Lipitor, Thief of Memory) — alongside published data from the Framingham Heart Study, the 4S, TNT, EXCEL, and IDEAL statin trials, and the Lyon Diet Heart Study. Every statistic in the document traces to these sources.

If you or someone you know has an appointment coming up where a statin will be discussed, print the Quick Reference page and take it with you.

Questions for Your Doctor — the series so far:

1. The PSA Test — available now

2. Mammogram Screening — available now

3. Colonoscopy — available now

4. The Childhood Vaccine Visit — available now

5. Statin Prescription — available now

If there is a screening test, a prescription, or a procedure where you needed the right questions before you walked into the room, put it in the comments.

The Questions for Your Doctor series is available exclusively to paid subscribers.

Statin Prescription: Questions for Your Doctor is available for download below.