The lawsuits claimed that pharmaceutical companies had concealed information about serious and permanent health risks associated with their statins. Indeed, the Food and Drug Administration issued warnings several years ago that linked statins to the risk of serious muscle, kidney or liver damage. What’s more, other patient-reported side effects of some statins included severe fatigue and a decline in cognitive function and motor skills. And separate reports found serious side effects when statins are used in conjunction with certain other meds.

To date, the FDA issued statin warnings primarily aimed at high-dosage patients. But almost 8 million Americans use the drugs to treat high cholesterol levels, according to the American Academy of Orthopaedic Surgeons.

Why are so many people on statins if such concerns abound? And at what point is it recommended to take them? For answers, let’s backtrack a bit.

Cholesterol and triglycerides are two major lipids (types of fat) that circulate in the blood. To circulate in the bloodstream, which contains water, these lipids must first bind with proteins. This fusion of lipids and proteins creates compounds called lipoproteins.

But there are both good and bad cholesterol lipoproteins. Density is what separates good lipoproteins from bad lipoproteins. (The density of a lipoprotein depends on the amount of protein in the molecule.) High density lipoproteins (HDL) contain cholesterol and high amounts of protein, which help absorb excess cholesterol in the bloodstream and transport it to the liver for disposal. HDL is sometimes referred to as “good” cholesterol. Low density lipoproteins (LDL) contain cholesterol and low amounts of protein. LDL is sometimes referred to as “bad” cholesterol.

Often, cholesterol is considered an artery-clogging villain that stalks victims and claims lives. But the truth is that without the waxy substance—which is made by the liver and found in all parts of the body—our bodies could not function normally.

As with most things, a little is good but too much is bad. The body uses cholesterol to produce many hormones, vitamin D, and bile acids, which help digest fat. Cholesterol also transports essential fatty acids (EFAs) to cell membranes throughout the body. Without enough cholesterol, the body can’t perform essential functions, including repairing and replacing cells.

In addition, cholesterol also helps us manage fats in the body. “When someone eats a fat soluble meal, carriers called lipoproteins transport and break down the fats so the body can use them for energy,” explains Icilma Fergus, MD, FACC, a cardiologist and assistant professor of clinical medicine at Columbia University Medical Center in New York City. Any excess or unused bad lipoproteins are stored as fat. That’s when these bad lipoprotein (LDL) numbers become elevated.”

When an exam shows that patients have elevated bad cholesterol levels, docs often run additional tests to confirm that patients’ cholesterol levels are truly elevated. “It’s best to get a true fasting cholesterol profile, with its different components: LDL, HDL and triglycerides,” Fergus says.

If test results show the patient has a truly elevated cholesterol level, then the doctor considers what kind of treatment—lifestyle modifications or meds—would work best for that person.

Fergus first recommends diet and exercise. But if the patient is unable to tolerate diet and exercise and is at increased risk of coronary artery disease or has definite risk factors, such as having a family history of heart disease or experiencing chest pain syndrome (angina), that’s when Fergus draws her biggest guns. “I’d immediately start that patient on a statin,” she says.

If statins are indicated, docs should monitor patients carefully for side effects. Fergus orders a baseline assessment of a patient’s liver function. “There’s certain things that we measure in the blood to make sure the liver is OK,” she says. “Once [a patient is] on the statin, a doctor should be following these numbers because they can become elevated. That could mean your liver may be having an adverse reaction to the statin.”

The reason why doctors closely monitor statin-taking patients’ liver function is because the drug may trigger an increase in liver enzyme production. This can lead to permanent liver damage. As a precaution, physicians usually recommend patients have a blood test six weeks after starting a statin to check their liver function. After that, the doctor may recommend an annual blood test.

When a patient complains about muscle pain, however, Fergus pays even closer attention. “It may not be that important if it’s a little cramping or something small,” she says. “But significant cramping to the point where we find elevated levels of CPK [creatine phosphokinase, an enzyme found mainly in the heart, brain, and skeletal muscle] in the blood, that means your muscles are actually beginning to break down—and that’s dangerous. If that’s the case, statins should be stopped immediately.”

But, sometimes, as the mounting numbers of statin lawsuits show, doctors aren’t as cautious as Fergus. One patient survey found that doctors often ignored patient complaints about muscle pain and other possible statin side effects.

For the survey, researchers from the University of California at San Diego polled 650 patients about this very topic. Researchers found that more often than not, doctors dismissed or ignored patients’ complaints about statin side effects such as muscle pain, cognitive impairment and finger and toe numbness—all symptoms duly noted in the literature about statin drugs’ side effects.

If a patient complains about any pain, cramps, muscle pain (myalgia) or discomfort, doctors should measure the CPK levels, Fergus reiterates.

But despite the concerns about statin side effects and their long-term safety profile, many doctors maintain that the drugs effectively deliver what they promise—cholesterol-lowering benefits.

“In general, they are very safe if followed in the proper manner,” Fergus says.

But then if doctors paid the proper attention to their statin patients’ complaints, there also might be fewer lawsuits pending. And that’s a good thing for everyone.