Does everyone over a certain age need a statin?

No. There's no age at which a statin is automatic. The decision is driven by your estimated cardiovascular risk, your cholesterol pattern, other conditions like diabetes or kidney disease, and your own preferences. Two people the same age can land on opposite answers because their overall risk is different. The Australian CVD risk calculator your GP uses is the starting point, not your age alone.

Should I take a low-dose aspirin every day to protect my heart?

For most people who have never had a heart attack or stroke, the evidence no longer supports routine daily aspirin. The large ASPREE trial in healthy older Australians found that daily low-dose aspirin did not prolong disability-free survival and increased serious bleeding. Aspirin still has a clear role for people who have already had a cardiovascular event — that's a different situation. If you're already taking aspirin, don't stop without talking to your GP; stopping abruptly can carry its own risks.

What blood pressure should I be aiming for?

There's no single number that suits everyone. Australian guidelines generally aim for under 140/90 mmHg, with a lower target (around 120 systolic) considered for some people at higher risk who tolerate it well. But the right target also weighs the downside of intensive treatment — dizziness, falls and lightheadedness, especially in older adults. It's a trade-off worth setting deliberately with your GP rather than chasing one universal figure.

I have diabetes — does that change the statin decision?

Often, yes. Diabetes raises cardiovascular risk, so a statin is more frequently recommended. Statins can nudge blood-sugar control slightly and very occasionally tip someone toward a diabetes diagnosis, but for people who already have diabetes the heart-and-stroke protection generally outweighs that small effect. The honest way to weigh it is to see both risks at their true size side by side, which is exactly what the conversation with your GP is for.

If my cholesterol is normal, can I still benefit from a statin?

Sometimes. Statins lower cardiovascular risk partly beyond their effect on the cholesterol number itself, so people with 'normal' cholesterol but high overall risk can still benefit. Conversely, a high cholesterol reading in someone at low overall risk may not justify a statin. This is why the decision rests on total risk, not a single line on a blood test.

Decision aid

Statins, aspirin & blood pressure — preventing heart attack and stroke

By Dr HB Lo, FACRRM Reviewed 14 June 2026 5 min read

General information to help you prepare for your GP — not a diagnosis, not personal medical advice. It doesn't replace a consultation, and using it doesn't create a doctor–patient relationship.

Preventing a first heart attack or stroke is rarely one yes-or-no call. It's a few separate decisions — whether a statin is worth it, whether daily aspirin helps or harms, and what blood pressure to aim for — and each one turns on your overall cardiovascular risk, not on a single reading.

In Australia the anchor is your estimated risk over the next five years, worked out with the Australian CVD risk calculator your GP uses. The higher that number, the more a preventive medicine tends to help; the lower it is, the more the side effects and bleeding risks weigh against it.

This guide lays out how each decision is actually made, so you can walk in ready to ask the questions that matter.

You’re not being asked to gamble — you’re being asked to weigh

Most people meet this conversation feeling slightly cornered. The blood test came back, a number was flagged, and now there’s a tablet on the table. It can feel like the choice is “do as you’re told” or “be the difficult patient.” It’s neither. Deciding about a statin, about daily aspirin, or about how hard to push your blood pressure is exactly the kind of thing a good appointment slows down for — and you’re allowed to slow it down too.

What follows is how each of these decisions is actually made in Australian general practice, so the questions you bring are the ones that move the needle.

Start with one number: your 5-year risk

Almost every preventive decision below hangs off the same foundation — your estimated risk of a heart attack or stroke over the next five years. Your GP works this out with the Australian CVD risk calculator, which combines age, sex, blood pressure, cholesterol, smoking, diabetes and a few other factors into a single percentage, following the Australian cardiovascular risk guideline.

That number reframes everything. A medicine that’s clearly worth it for someone at high risk can be barely worth it — or not worth it — for someone at low risk, even if their cholesterol reading looks identical. As the RACGP frames it, prevention is about absolute risk, not about treating a single line on a report. So the first question is rarely “is my cholesterol high?” It’s “what’s my overall risk, and what would treatment actually change?”

The statin decision

A statin lowers cholesterol and, more importantly, lowers the chance of a future heart attack or stroke. How much it lowers that chance depends on where you start. For someone at high risk, the benefit is substantial; for someone at low risk, the same tablet shifts a small number by a small amount, per Therapeutic Guidelines and Australian Prescriber.

The honest counterweights are real but modest for most people: muscle aches (common but often not actually caused by the statin when tested carefully), a small effect on blood sugar, and rare liver-enzyme changes that are monitored, as set out in the Australian Medicines Handbook and summarised for patients by HealthDirect. The useful move is to see the benefit and the harm at the same scale — as a count out of a hundred people like you over five years — rather than as a vague “good for the heart” against a vague “side effects.” That is the work the statin decision aid below is built to do.

A statin is an option to weigh, not an instruction here. Whether to start one is a decision for you and your GP, who can put your specific numbers into the picture.

The aspirin question — and why the advice changed

For years, a daily low-dose aspirin was widely taken as a heart-protective habit by healthy people. The evidence has moved. The large Australian-led ASPREE trial (NEJM 2018) randomised healthy older adults to daily aspirin or placebo and found it did not prolong disability-free survival, while it did increase serious bleeding. On the back of that and similar trials, routine aspirin for people who have never had a cardiovascular event is no longer generally recommended, per Therapeutic Guidelines.

This is different for people who have already had a heart attack or stroke, where aspirin has a clear established role. And if you’re currently taking daily aspirin, the message is not “stop” — it’s “ask,” because stopping abruptly can carry its own risk. The aspirin decision aid below lays out the bleeding-versus-benefit trade-off in plain numbers so you can have that conversation on solid ground.

Statin plus diabetes — two risks at honest sizes

If you have diabetes, the statin conversation shifts. Diabetes itself raises cardiovascular risk, so a statin is recommended more often, as both the Heart Foundation and Diabetes-focused guidance in eTG reflect. The wrinkle people hear about is that statins can nudge blood-sugar control slightly. For someone who already has diabetes, the heart-and-stroke protection generally outweighs that small effect — but the only fair way to decide is to see both risks at their true sizes rather than letting the smaller one dominate the conversation. The statin-with-diabetes decision aid below puts them side by side.

The blood pressure target — a number with a spread

“What should my blood pressure be?” sounds like it has one answer. It doesn’t. Australian practice generally aims for under 140/90 mmHg, with a tighter target (around 120 systolic) considered for some higher-risk people who tolerate treatment well, per eTG and explained for patients by HealthDirect.

The reason it’s a spread, not a single figure, is the trade-off: aiming lower prevents more strokes, but pushing harder also means more dizziness, lightheadedness and falls — which matters more as you get older. Your age, your steadiness on your feet, and how you tolerate the tablets all move the target. The blood pressure target decision aid below helps you see that trade-off and settle the number deliberately with your GP, rather than chasing one universal goal.

The questions worth taking in

What’s my 5-year cardiovascular risk, and what would each treatment change about it?
For me specifically, how big is the benefit compared with the side effects or bleeding risk?
If I start, how and when will we check it’s helping and not causing problems?
What can I change without a tablet — and how much would that move my risk on its own?

These are questions, not conclusions. The point is to walk in able to decide with your GP.

What this is, and is not

This is general information to help you prepare for your GP — not a diagnosis, and not personal medical advice. It doesn’t tell you to start, stop or change any medicine; those decisions are made with your own doctor, who can weigh your actual numbers and history. For consumer-friendly Australian background, see HealthDirect and the Better Health Channel.

Related on this site: the explainers go deeper on the pieces — cholesterol and cardiovascular risk, high blood pressure, and statin intolerance — and the type 2 diabetes treatment decision aid covers the closely linked metabolic side.

If you want a thorough, unhurried work-up of your own cardiovascular picture, you can work with Dr Lo.

Author: Dr Hoe Bing Lo — AHPRA MED0001212640 · FACRRM. Fun Doctors Pty Ltd · ABN 83 404 436 330.

Tools to take to your GP

Each runs in your browser — nothing you enter is stored or sent anywhere. They help you prepare the questions and print a one-page summary to bring to your appointment. They don't diagnose or recommend a specific treatment.

Frequently asked questions

Does everyone over a certain age need a statin?

No. There's no age at which a statin is automatic. The decision is driven by your estimated cardiovascular risk, your cholesterol pattern, other conditions like diabetes or kidney disease, and your own preferences. Two people the same age can land on opposite answers because their overall risk is different. The Australian CVD risk calculator your GP uses is the starting point, not your age alone.
Should I take a low-dose aspirin every day to protect my heart?

For most people who have never had a heart attack or stroke, the evidence no longer supports routine daily aspirin. The large ASPREE trial in healthy older Australians found that daily low-dose aspirin did not prolong disability-free survival and increased serious bleeding. Aspirin still has a clear role for people who have already had a cardiovascular event — that's a different situation. If you're already taking aspirin, don't stop without talking to your GP; stopping abruptly can carry its own risks.
What blood pressure should I be aiming for?

There's no single number that suits everyone. Australian guidelines generally aim for under 140/90 mmHg, with a lower target (around 120 systolic) considered for some people at higher risk who tolerate it well. But the right target also weighs the downside of intensive treatment — dizziness, falls and lightheadedness, especially in older adults. It's a trade-off worth setting deliberately with your GP rather than chasing one universal figure.
I have diabetes — does that change the statin decision?

Often, yes. Diabetes raises cardiovascular risk, so a statin is more frequently recommended. Statins can nudge blood-sugar control slightly and very occasionally tip someone toward a diabetes diagnosis, but for people who already have diabetes the heart-and-stroke protection generally outweighs that small effect. The honest way to weigh it is to see both risks at their true size side by side, which is exactly what the conversation with your GP is for.
If my cholesterol is normal, can I still benefit from a statin?

Sometimes. Statins lower cardiovascular risk partly beyond their effect on the cholesterol number itself, so people with 'normal' cholesterol but high overall risk can still benefit. Conversely, a high cholesterol reading in someone at low overall risk may not justify a statin. This is why the decision rests on total risk, not a single line on a blood test.

Source quality

Sources grouped by evidence tier. Australian primary tier first; international where Australia is silent or lagging. How tiers work.

If you want a thorough, unhurried work-up of your own — not a generic answer — you can work with Dr Lo.