Roughly 200 million people worldwide take statins, making them one of the most prescribed drug classes in history. In the United States alone, an estimated 40 million adults use a statin to lower cholesterol, and that number continues to climb. Yet even at these volumes, a significant gap exists between how many people could benefit from statins and how many actually take them.
Statin Use in the United States
About 1 in 4 American adults over age 40 takes a cholesterol-lowering medication, and 93% of those medications are statins. The likelihood of being on a statin rises sharply with age. Among adults 40 to 59, roughly 17% use one. That jumps to 43% of adults between 60 and 74, and nearly 48% of those 75 and older.
Under current guidelines, about 96 million U.S. adults either clearly qualify for statin therapy or fall into a category where it should be seriously considered. Fewer than half of those people actually take one. The gap is especially wide for primary prevention, meaning people who haven’t yet had a heart attack or stroke but are at elevated risk. Only about 34% of adults recommended statins for primary prevention report using them. Among people with diabetes between ages 40 and 75, just 47% take a statin despite clear guideline recommendations.
People who have already experienced a cardiovascular event are more likely to be on a statin, but even there, uptake isn’t universal. About 60% to 75% of adults recommended or considered for statins after a heart attack or stroke report taking one.
How Statin Use Varies Globally
Statin use is concentrated in wealthier countries. Global utilization rose about 25% between 2015 and 2020, but the increase has not been evenly distributed. In 2020, high-income countries used statins at more than six times the rate of low- and middle-income countries.
North America leads by a wide margin, with utilization rates nearly double those of Europe. Europe sits in second place, followed by Latin America and the Middle East/North Africa region at roughly similar levels. East Asia, Sub-Saharan Africa, and South Asia trail far behind. South Asia has the lowest utilization rate globally, despite carrying a heavy burden of heart disease. This pattern means hundreds of millions of people in lower-income countries who would benefit from statins simply don’t have access to them.
Who Gets Prescribed Statins and Who Doesn’t
Statin prescribing isn’t equal across demographic groups, even among people with comparable heart disease risk. Men are more likely to receive and stay on statins than women. After an acute heart event, about 81% of men are discharged on guideline-recommended statin therapy compared to roughly 72% of women. At follow-up visits, the gap persists: 65% of men remain on therapy versus 58% of women. Women are also less likely to reach their cholesterol targets after starting treatment.
Racial disparities show a similar pattern. Among patients who would clearly benefit from a statin, Black patients are significantly less likely to receive a prescription than white patients, even after adjusting for blood pressure, cholesterol levels, and other risk factors. One large health system analysis found that Black patients had about 42% lower odds of being prescribed a statin compared to white patients with equivalent risk profiles. The raw prescribing rates were 30% for white patients and 27% for Black patients, but the adjusted analysis revealed the gap was driven by clinical decision-making rather than differences in patient characteristics.
Why So Many People Don’t Take Them
The gap between who should be on a statin and who actually is comes down to three groups: people who were never offered one, people who were offered one and declined, and people who started but stopped. Among adults recommended for statin therapy but not currently taking one, about 59% say they were never offered a statin by their doctor in the first place. Another 31% had previously taken a statin but discontinued it, and about 10% were offered one and said no.
Among those who quit, side effects are the dominant reason. Roughly 55% of people who stopped their statin cited perceived side effects, most commonly muscle pain or weakness. About half of those who discontinued had been on the medication for a year or more before stopping, while 30% quit within the first year and about 13% stopped within the first month. The “never offered” group represents the largest missed opportunity and points to a systemic issue in how cardiovascular risk is assessed during routine medical visits.
The Borderline Risk Group
A particularly large pool of potential statin users sits in what guidelines call the borderline or intermediate risk category. These are people who don’t have established heart disease but do carry risk factors like high blood pressure, elevated cholesterol, a family history of heart attacks, or chronic inflammation. About three-quarters of U.S. adults in this risk range are not taking a statin. Among those with at least one risk-enhancing factor, only 23% use one. That translates to roughly 7.2 million Americans who have identifiable risk factors, aren’t on a statin, and could potentially benefit from starting one.
This group tends to fall through the cracks because the decision to prescribe involves a conversation about individual risk rather than a straightforward clinical trigger. Guidelines recommend a shared discussion between patient and doctor, but in practice, time-pressed appointments often mean the conversation never happens.
Primary vs. Secondary Prevention
Statin users fall into two broad categories. People taking statins for secondary prevention already have heart disease or have had a cardiovascular event and are using the medication to prevent another one. People on statins for primary prevention are trying to avoid a first event. The vast majority of statin users fall into the primary prevention category by sheer population size, but secondary prevention patients take statins at far higher rates individually. Data from England’s health system shows that between 68% and 72% of patients qualifying for secondary prevention used a statin over a recent 12-year period, compared to just 9% to 11% of those qualifying for primary prevention. That enormous gap in primary prevention uptake is consistent across most countries and represents the biggest area where statin use could expand.