Statins, HMG-CoA reductase inhibitors, are the primary treatment for cardiovascular diseases, the leading global cause of mortality. They reduce LDL cholesterol, lower cardiovascular risk, and have pleiotropic effects such as improving endothelial function, reducing inflammation, and stabilizing atherosclerotic plaques. However, statins are associated with adverse effects like muscle symptoms, diabetes, liver toxicity, kidney disease, cataracts, hemorrhagic stroke, and psychiatric issues. These side effects, termed statin-associated symptoms (SAS), are rare in clinical trials but can lead to dose adjustments or discontinuation. Statins are generally safe and well-tolerated, with significant benefits in reducing cardiovascular events. They also have anti-inflammatory, anti-thrombotic, and antioxidant properties, and may offer protection against noise-induced hearing loss and enhance immune checkpoint blockade in cancer models. However, statins can cause myopathy, rhabdomyolysis, and increase diabetes risk. Liver damage is rare, but statins may raise the risk of hemorrhagic stroke in those with cerebrovascular disease. Kidney disease and tendon rupture are also potential side effects. While statins are effective, non-statin options like PCSK9 inhibitors and bempedoic acid are emerging as alternatives. Overall, statins remain crucial for cardiovascular risk reduction, but their use should be carefully managed to balance benefits and risks.Statins, HMG-CoA reductase inhibitors, are the primary treatment for cardiovascular diseases, the leading global cause of mortality. They reduce LDL cholesterol, lower cardiovascular risk, and have pleiotropic effects such as improving endothelial function, reducing inflammation, and stabilizing atherosclerotic plaques. However, statins are associated with adverse effects like muscle symptoms, diabetes, liver toxicity, kidney disease, cataracts, hemorrhagic stroke, and psychiatric issues. These side effects, termed statin-associated symptoms (SAS), are rare in clinical trials but can lead to dose adjustments or discontinuation. Statins are generally safe and well-tolerated, with significant benefits in reducing cardiovascular events. They also have anti-inflammatory, anti-thrombotic, and antioxidant properties, and may offer protection against noise-induced hearing loss and enhance immune checkpoint blockade in cancer models. However, statins can cause myopathy, rhabdomyolysis, and increase diabetes risk. Liver damage is rare, but statins may raise the risk of hemorrhagic stroke in those with cerebrovascular disease. Kidney disease and tendon rupture are also potential side effects. While statins are effective, non-statin options like PCSK9 inhibitors and bempedoic acid are emerging as alternatives. Overall, statins remain crucial for cardiovascular risk reduction, but their use should be carefully managed to balance benefits and risks.