Sjogren’s, Cholesterol, and Statins: 5 Questions to Ask Your Doctor
You just got your lab results back, and your doctor says your cholesterol is high. The next word you hear is "statin." For someone living with Sjogren's Disease, this can feel confusing and even scary. Do you really need it? Are there other options? Could it make your muscle pain worse?
As a board-certified allergist, immunologist, and lifestyle medicine physician – and a Sjogren's patient myself – I understand the importance of this conversation. I am not anti-medication; medications save lives! I am pro-information and pro-empowerment. You deserve to understand your options and be an active partner in your healthcare decisions.
Today, we're talking about five key questions you should ask your doctor before saying yes or no to a statin when you have Sjogren's or another autoimmune condition.
Why Sjogren’s Changes the Cholesterol Conversation
As we've discussed throughout this series, your cardiovascular risk with Sjogren's isn't just about your cholesterol number; it's about the inflammatory environment your cholesterol is floating in. Think of it this way: cholesterol traveling through a calm, healthy blood vessel is very different from cholesterol traveling through an inflamed, irritated one.
Inflammation changes everything. It makes cholesterol more likely to stick to vessel walls, become oxidized (making it more dangerous), and contribute to plaque formation. This can happen even if your traditional risk factors, like your LDL ("bad") cholesterol, look normal.
Sometimes, lowering cholesterol with a statin is the right, life-saving choice. But other times, especially with mild to moderate elevations, the driving force behind your risk is inflammation. Focusing on lowering that underlying inflammation first might be a more effective and foundational strategy. This is why one-size-fits-all approaches don't always work for us.
5 Questions to Transform the Statin Conversation
If your doctor brings up statins, here are five questions to turn a quick prescription into a collaborative, informed decision:
1. "Beyond my LDL, what do my other numbers tell you about my cardiovascular risk?"
This shows you're thinking holistically. You want to know about your:
Triglycerides: Elevated levels are often a sign of insulin resistance.
HDL ("good") cholesterol: Helps remove cholesterol from your arteries.
Triglyceride to HDL Ratio: A powerful indicator of inflammation, even with normal LDL.
Inflammatory Markers (like hs-CRP): A direct measurement of systemic inflammation.
2. "Is it possible that inflammation from my Sjogren's is driving my high cholesterol?"
This is a sophisticated question based on real science. Chronic inflammation from Sjogren’s, uncontrolled allergies, or even poor sleep signals your liver to produce more cholesterol as part of a repair mechanism. In chronic inflammatory conditions, this becomes maladaptive. If inflammation is the root cause, addressing it through better Sjogren’s management and anti-inflammatory lifestyle changes might improve your cholesterol numbers without medication.
3. "What specific lifestyle changes would be most impactful for me as someone with an autoimmune condition?"
This positions you as a committed partner. Generic advice like "eat less fat, exercise more" doesn't cut it. Ask about specifics:
Diet: Should I follow an anti-inflammatory diet? What does that look like?
Exercise: What movement is most beneficial for cardiovascular health without triggering fatigue or joint pain?
Stress Management: What techniques do you recommend to lower inflammation?
Sleep: If I'm having sleep issues, what should I prioritize to improve it?
Your doctor may recommend connecting with other experts (a registered dietitian, physical therapist, or sleep medicine physician) as part of your team.
4. "What are the potential side effects I should watch for, especially muscle pain, given my Sjogren's-related aches?"
This is a valid and important concern. One of the most common side effects of statins is muscle pain (myalgias). For those of us with Sjogren's, it can be hard to distinguish baseline aches from a medication side effect. Opening this conversation before starting the medication helps create a collaborative monitoring plan.
5. "Can we consider a three-month trial of intensive lifestyle changes and then recheck my numbers before I start a medication?"
This is the ultimate collaborative question, often appropriate for those with mild to moderately elevated cholesterol and no other major risk factors. You're proposing a defined period to commit to intensive lifestyle changes:
Adopt a truly anti-inflammatory diet.
Implement a consistent, appropriate exercise routine.
Prioritize 7-9 hours of quality sleep.
Add stress management practices.
Consider targeted supplements (with your doctor's guidance).
After three months, you recheck your numbers. If they've improved significantly, you may not need medication, or you could start a much lower dose. If they haven't, you can start a statin with the confidence that it’s necessary and that you’ve built a strong lifestyle foundation to support it.
My Philosophy: A Nuanced, Personalized Approach
Statins are life-saving medications when used for the right person at the right time. But they aren't the only tool in our toolbox. My approach is to first meet patients where they are. If they're motivated to aggressively address lifestyle factors driving inflammation, let's do it. Let's get the autoimmune disease as well-controlled as possible and check inflammatory markers. Then, we re-evaluate cholesterol and have a truly informed, collaborative conversation about whether medication is necessary.
This is the kind of nuanced, personalized medicine that everyone deserves, especially those of us managing complex chronic conditions.
You deserve to know your numbers, and you deserve a plan that actually connects the dots.
Have you had a real conversation with your doctor about heart health in the context of your autoimmune disease? What is the one question you still have after watching this? Share in the comments below!
