High cholesterol: Should I take statins?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

High cholesterol: Should I take statins?

Get the facts

Your options

  • Start taking medicine for high cholesterol.
  • Don't take medicine. Try lowering your cholesterol with lifestyle changes.

Key points to remember

  • You may be able to improve your high cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take medicines called statins or statin combinations to lower your cholesterol.
  • If you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, you may need to start taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.
  • Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol.
  • Statins can lower your risk of having a heart attack or a stroke.
  • Statins have few side effects. Any side effects, such as muscle aches, feeling tired, or having an upset stomach, are most likely when higher doses are used. Statins do not cause side effects in most people.
  • Even with medicine, you will need healthy habits for the rest of your life to lower your risk of a heart attack.
FAQs

What is high cholesterol?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But if you have too much, it starts to build up in your arteries. The higher your cholesterol, the greater your risk for heart disease. Too much cholesterol in your blood can lead to a heart attack or a stroke.

There are two kinds of cholesterol.

Triglycerides are another type of fat in the blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

A simple blood test tells you how much cholesterol you have. The test results are given in numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To find out this risk, your doctor will also consider your age, your family history, your blood pressure, and if you smoke.

  • LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
  • HDL should be high. A good HDL goal is 40 or higher. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. A high HDL number can help offset a high LDL number.
  • Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What increases your risk for heart disease and heart attack?

High cholesterol is just one of several risk factors that make heart attacks or strokes more likely. If you have high cholesterol and another risk factor, heart attacks and strokes are even more likely. Some risk factors are things you may be able to control. Others are things you can't control.

Risk factors you may be able to control include:

Risk factors that you can'tcontrol include:

  • Your age. Men age 45 or older and women age 55 or older have a higher risk.
  • Having one or more close relatives who have or had early heart disease.

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

How is high cholesterol treated?

Therapeutic lifestyle changes and medicines called statins are the two main treatments for high cholesterol. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack or a stroke. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps lower your risk of heart problems.

The way high cholesterol is treated will depend on your cholesterol levels, your risk for a heart attack, and your personal preference about taking medicines.

Why are lifestyle changes so important?

Some people can lower their cholesterol just by making lifestyle changes such as eating less saturated fat, losing weight, exercising, and quitting smoking.. Others will need to take pills as well. But some lifestyle changes are important for everyone with high cholesterol. Even with statins, you will need healthy habits for the rest of your life to lower your risk of a heart attack.

If you decide to try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try lifestyle changes for 3 to 6 months. If your cholesterol doesn't come down enough in that time, you may decide to start taking statins.

If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take pills to keep your cholesterol down. And if you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, your doctor may want you to starting taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.

How can statins help lower cholesterol?

Statins and statin combinations are medicines that reduce the body's natural production of cholesterol. They make "bad" LDL cholesterol levels in the blood go down and help lower triglycerides. Statins can also raise "good" HDL cholesterol. Statins may be used alone, or they may be combined with other medicines.

Guidelines from the United States National Cholesterol Education Panel advise use of statins in people who are at moderate to high risk of coronary artery disease.1

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

Studies show that statins and statin combinations can:

  • Slow the spreadof heart disease.2, 3
  • Lower the risk of heart attack.
  • Lower stroke risk.
  • Reduce LDL by 18% to 55%.4 This means that if your LDL is 200, taking a statin could lower your LDL to between 164 and 90.
  • Increase HDLby 5% to 15%.4 This means that if your HDL is 60, taking a statin could increase your HDL to between 63 and 69. The higher your HDL, the better. An HDL of 60 and higher protects against heart disease.

You'll need blood tests to check your liver each year while you are taking the pills. Statins may cause liver problems, and the blood tests check how well your liver is working.

Why might your doctor recommend taking statins?

Your doctor may recommend that you take statins or statin combinations if:

  • You have high "bad" LDL cholesterol and low "good" HDLcholesterol.
  • You have diabetes, high blood pressure, or heart disease.
  • You are at high risk of having a heart attack, or you already have heart problems.
  • You have tried being more active and changing your diet, but these changes did not lower your cholesterol enough.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take statins to lower your cholesterol Take statins to lower your cholesterol
  • You take a pill or combination of pills every day for the rest of your life.
  • You see your doctor for regular blood tests to check how well your liver is working.
  • Studies show that statins and statin combinations can:
    • Lower "bad" LDL cholesterol and increase "good" HDL cholesterol.
    • Slow the spread of coronary artery disease.
    • Lower the risk of a heart attack.
    • Lower the risk of a stroke.
  • Statins don't cause side effects in most people. But possible side effects can include:
    • Minor muscle aches.
    • Tiredness
    • Upset stomach.
    • Gas.
    • Constipation.
    • Belly pain or cramps.
    • Severe muscle pain (not common).
  • These medicines can be costly.
Don't take statins Don't take statins
  • You may be able to lower your cholesterol by making healthy changes.
  • You avoid taking pills every day.
  • You avoid the cost of pills.
  • Lifestyle changes may not be enough to lower your cholesterol.
  • You may still be at risk for a heart attack or a stroke if your cholesterol is too high.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Stories about deciding whether to use medicine for high cholesterol

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I don't like taking pills all the time, and I would have to take the cholesterol medicines for the rest of my life to keep getting any benefit from them. My only other risk factor is high blood pressure. I need to eat a low-fat diet and get enough exercise to help keep my weight under control, so I'm going to see if I can get my cholesterol down a little bit that way (and maybe help my blood pressure, too).

Carole, age 58

My dad died of a heart attack when he was in his 50s. I must have inherited my high cholesterol from him. I don't want to die before my time, and I haven't been able to get my cholesterol down very much by eating a low-fat diet. I am going to try the medicines.

Charles, age 48

Heart disease runs in our family, so I know I need to be concerned about my cholesterol and all those other risk factors. The most important thing for me right now is to quit smoking. From what I have read, quitting smoking will help reduce my risk of heart disease, lung cancer, and other problems, and it might help just as much as lowering my cholesterol would help. It will also be better for my family and will save money.

Diego, age 41

I just found out that I have high cholesterol. Being a smoker, my risk of heart disease is already higher, and now I have another risk factor to worry about. I have tried many times to quit smoking, but it has never worked. I want to reduce my risk of heart disease, so I would like to try taking medicines. If I have some success with that, maybe it will help motivate me to finally quit smoking.

Becky, age 56

For more information, see the topic High Cholesterol.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.

I want to try to make lifestyle changes to help lower my cholesterol.

More important
Equally important
More important

I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.

I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.

More important
Equally important
More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important
Equally important
More important

I worry about having a heart attack, and I want to do everything I can to prevent it.

I'm not that worried about having a heart attack.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is taking medicine the only way to lower your cholesterol?

  • Yes Sorry, that's not right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • No You're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • I'm not sure It may help to go back and read "Why are lifestyle changes so important?" You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weigh, exercising, and quitting smoking.
2.

Can statin medicines help you lower your risk of having a heart attack or stroke?

  • Yes You're right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
  • No Sorry, that's not right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
  • I'm not sure It may help to go back and read "How can statins help lower cholesterol?" Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.
3.

Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?

  • Yes You're right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.
  • No Sorry, that's not right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.
  • I'm not sure It may help to go back and read "Why are lifestyle changes so important?" Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology

References
Citations
  1. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
  2. Cannon CP, et al. (2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
  3. Nissen SE, et al. (2004). Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. JAMA, 291(9): 1071–1080.
  4. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.

High cholesterol: Should I take statins?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Start taking medicine for high cholesterol.
  • Don't take medicine. Try lowering your cholesterol with lifestyle changes.

Key points to remember

  • You may be able to improve your high cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.
  • If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take medicines called statins or statin combinations to lower your cholesterol.
  • If you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, you may need to start taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.
  • Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol.
  • Statins can lower your risk of having a heart attack or a stroke.
  • Statins have few side effects. Any side effects, such as muscle aches, feeling tired, or having an upset stomach, are most likely when higher doses are used. Statins do not cause side effects in most people.
  • Even with medicine, you will need healthy habits for the rest of your life to lower your risk of a heart attack.
FAQs

What is high cholesterol?

Cholesterol is a type of fat. Your body needs it for many things, such as making new cells. But if you have too much, it starts to build up in your arteries. The higher your cholesterol, the greater your risk for heart disease. Too much cholesterol in your blood can lead to a heart attack or a stroke.

There are two kinds of cholesterol.

Triglycerides are another type of fat in the blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

A simple blood test tells you how much cholesterol you have. The test results are given in numbers. Your cholesterol numbers help your doctor know your risk of heart attack. To find out this risk, your doctor will also consider your age, your family history, your blood pressure, and if you smoke.

  • LDL should be low. Your LDL goal depends on your risk of heart attack and stroke. If you are at very high risk, your goal may be less than 70. If you are at high risk, your goal is less than 100. If you are at moderate risk, your goal is less than 130. If you are at low risk, your goal is less than 160.
  • HDL should be high. A good HDL goal is 40 or higher. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. A high HDL number can help offset a high LDL number.
  • Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What increases your risk for heart disease and heart attack?

High cholesterol is just one of several risk factors that make heart attacks or strokes more likely. If you have high cholesterol and another risk factor, heart attacks and strokes are even more likely. Some risk factors are things you may be able to control. Others are things you can't control.

Risk factors you may be able to control include:

Risk factors that you can'tcontrol include:

  • Your age. Men age 45 or older and women age 55 or older have a higher risk.
  • Having one or more close relatives who have or had early heart disease.

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

How is high cholesterol treated?

Therapeutic lifestyle changes and medicines called statins are the two main treatments for high cholesterol. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack or a stroke. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps lower your risk of heart problems.

The way high cholesterol is treated will depend on your cholesterol levels, your risk for a heart attack, and your personal preference about taking medicines.

Why are lifestyle changes so important?

Some people can lower their cholesterol just by making lifestyle changes such as eating less saturated fat, losing weight, exercising, and quitting smoking.. Others will need to take pills as well. But some lifestyle changes are important for everyone with high cholesterol. Even with statins, you will need healthy habits for the rest of your life to lower your risk of a heart attack.

If you decide to try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try lifestyle changes for 3 to 6 months. If your cholesterol doesn't come down enough in that time, you may decide to start taking statins.

If high cholesterol runs in your family, you may not be able to lower it with lifestyle changes alone. You may need to take pills to keep your cholesterol down. And if you have high cholesterol and diabetes, high blood pressure, or coronary artery disease, your doctor may want you to starting taking medicine right away. That's because your chances of having a heart attack are high, and statins can reduce this risk.

How can statins help lower cholesterol?

Statins and statin combinations are medicines that reduce the body's natural production of cholesterol. They make "bad" LDL cholesterol levels in the blood go down and help lower triglycerides. Statins can also raise "good" HDL cholesterol. Statins may be used alone, or they may be combined with other medicines.

Guidelines from the United States National Cholesterol Education Panel advise use of statins in people who are at moderate to high risk of coronary artery disease.1

To find out your risk of a heart attack, you can use the Interactive Tool: Are You at Risk for a Heart Attack?

Studies show that statins and statin combinations can:

  • Slow the spreadof heart disease.2, 3
  • Lower the risk of heart attack.
  • Lower stroke risk.
  • Reduce LDL by 18% to 55%.4 This means that if your LDL is 200, taking a statin could lower your LDL to between 164 and 90.
  • Increase HDLby 5% to 15%.4 This means that if your HDL is 60, taking a statin could increase your HDL to between 63 and 69. The higher your HDL, the better. An HDL of 60 and higher protects against heart disease.

You'll need blood tests to check your liver each year while you are taking the pills. Statins may cause liver problems, and the blood tests check how well your liver is working.

Why might your doctor recommend taking statins?

Your doctor may recommend that you take statins or statin combinations if:

  • You have high "bad" LDL cholesterol and low "good" HDLcholesterol.
  • You have diabetes, high blood pressure, or heart disease.
  • You are at high risk of having a heart attack, or you already have heart problems.
  • You have tried being more active and changing your diet, but these changes did not lower your cholesterol enough.

2. Compare your options

  Take statins to lower your cholesterol Don't take statins
What is usually involved?
  • You take a pill or combination of pills every day for the rest of your life.
  • You see your doctor for regular blood tests to check how well your liver is working.
What are the benefits?
  • Studies show that statins and statin combinations can:
    • Lower "bad" LDL cholesterol and increase "good" HDL cholesterol.
    • Slow the spread of coronary artery disease.
    • Lower the risk of a heart attack.
    • Lower the risk of a stroke.
  • You may be able to lower your cholesterol by making healthy changes.
  • You avoid taking pills every day.
  • You avoid the cost of pills.
What are the risks and side effects?
  • Statins don't cause side effects in most people. But possible side effects can include:
    • Minor muscle aches.
    • Tiredness
    • Upset stomach.
    • Gas.
    • Constipation.
    • Belly pain or cramps.
    • Severe muscle pain (not common).
  • These medicines can be costly.
  • Lifestyle changes may not be enough to lower your cholesterol.
  • You may still be at risk for a heart attack or a stroke if your cholesterol is too high.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic High Cholesterol.

Stories about deciding whether to use medicine for high cholesterol

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I don't like taking pills all the time, and I would have to take the cholesterol medicines for the rest of my life to keep getting any benefit from them. My only other risk factor is high blood pressure. I need to eat a low-fat diet and get enough exercise to help keep my weight under control, so I'm going to see if I can get my cholesterol down a little bit that way (and maybe help my blood pressure, too)."

— Carole, age 58

"My dad died of a heart attack when he was in his 50s. I must have inherited my high cholesterol from him. I don't want to die before my time, and I haven't been able to get my cholesterol down very much by eating a low-fat diet. I am going to try the medicines."

— Charles, age 48

"Heart disease runs in our family, so I know I need to be concerned about my cholesterol and all those other risk factors. The most important thing for me right now is to quit smoking. From what I have read, quitting smoking will help reduce my risk of heart disease, lung cancer, and other problems, and it might help just as much as lowering my cholesterol would help. It will also be better for my family and will save money."

— Diego, age 41

"I just found out that I have high cholesterol. Being a smoker, my risk of heart disease is already higher, and now I have another risk factor to worry about. I have tried many times to quit smoking, but it has never worked. I want to reduce my risk of heart disease, so I would like to try taking medicines. If I have some success with that, maybe it will help motivate me to finally quit smoking."

— Becky, age 56

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I've tried eating better and being more active, but doing these things hasn't lowered my cholesterol enough.

I want to try to make lifestyle changes to help lower my cholesterol.

More important
Equally important
More important

I don't mind taking medicine for the rest of my life if it will reduce my risk of heart attack.

I hate the idea of taking pills for the rest of my life, even if they will reduce my risk of heart attack.

More important
Equally important
More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important
Equally important
More important

I worry about having a heart attack, and I want to do everything I can to prevent it.

I'm not that worried about having a heart attack.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is taking medicine the only way to lower your cholesterol?

  • Yes
  • No
  • I'm not sure
You're right. You may be able to lower your cholesterol with lifestyle changes, such as eating less saturated fat, losing weight if you need to, exercising, and quitting smoking.

2. Can statin medicines help you lower your risk of having a heart attack or stroke?

  • Yes
  • No
  • I'm not sure
You're right. Statins can reduce "bad" LDL cholesterol and increase "good" HDL cholesterol. They also lower the risk of having a heart attack or stroke.

3. Do you still need healthy habits even when you're taking statin medicines to lower your cholesterol?

  • Yes
  • No
  • I'm not sure
You're right. Even with statins, you will also need healthy habits for the rest of your life to lower your risk of heart attack.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology

References
Citations
  1. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
  2. Cannon CP, et al. (2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
  3. Nissen SE, et al. (2004). Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. JAMA, 291(9): 1071–1080.
  4. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: January 30, 2009

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