Statins – a group of drugs used to lower cholesterol and heart disease risk – are widely prescribed but have had a lot of negative press over the years.
We set out what you need to know if you have been advised to start taking them.
1. What do statins do?
Statins slow down the liver’s production of cholesterol by interfering with a key enzyme. As a reaction to the reduced production, the liver takes more low-density lipoprotein (LDL), often known as ‘bad cholesterol’, from the blood, which leads to lowers levels circulating around the body.
Statins are recommended for people who have already had a heart attack, stroke or have other signs of vascular disease. They are also recommended to people who are at increased risk of developing coronary heart disease or stroke, regardless of their cholesterol levels.
2. Are statins safe?
Yes. A Cochrane review (the gold standard of research reviews) found that statins were effective in reducing cardiovascular disease and did not increase the risk of serious adverse effects, such as cancer. This doesn’t mean they are always free of side effects, but most people tolerate them well.
One of the most widely reported side effects is muscle aches and pains. But it isn’t clear whether some of the patients reporting these aches would have experienced them anyway as part of normal ageing.
If you do experience side effects after starting statins, you should discuss them with your GP, rather than stop taking the medicine. Your GP may be able to adjust your dose to reduce the negative effects.
More serious side effects are possible but are very rare.
3. It’s still your decision whether to take statins
Statins can be offered to anyone with a 10-year cardiovascular risk of over 10%, according to The National Institute for Health and Care Excellence (NICE) guidelines. A few years ago, the guideline was 20%.
But Dr Samuel Finnikin, a GP and clinical research fellow at the University of Birmingham, says that while statins do reduce the risk of cardiovascular disease, it is important for each patient to discuss their individual risks and benefits with their doctors. That way, the patient can make the right decision for them.
If you visit your GP wanting to know your risks, or you go for an NHS Health Check for the over-40s, they will perform a cardiovascular risk assessment using a risk calculator called QRISK2. This uses numerous risk factors, including cholesterol and blood pressure, to come up with an estimated risk of you having a heart attack or stroke in the next 10 years.
There are versions of the QRISK2 you can try online, including this Absolute CVD Risk/Benefit Calculator (make sure you select QRISK2-2014 at the top). It allows you to see how different lifestyle changes and medications will impact on your risks.
Whatever your risk, if it is 10% or higher, your doctor should discuss lifestyle changes with you first. They then may offer you statins.
Even if you feel certain you don’t want to take medication, it’s worth finding out your risk percentage to make a fully informed decision. If you want to try lifestyle changes before starting statins, your doctor should offer support and reassess your risk of cardiovascular disease after a period of attempting these changes.
4. You still need to change your lifestyle
Taking statins doesn’t remove the need to make positive lifestyle changes to reduce your risk of heart disease and high cholestorol. Statins should be used alongside a healthy lifestyle, not as an alternative, and you’ll reap much more benefit from combining the two rather than one alone.
Heart UK dietitian Linda Main gives the following tips to improve your levels of ‘good’ or HDL cholesterol and reduce your LDL:
- Measure your waistline at its widest point, and lose inches if you need to.
- Stop smoking.
- Swap out saturated fats for poly and mono-unsaturated – olive and rapeseed oil are good sources.
- Follow a Mediterranean diet.
- Keep your alcohol intake within healthy limits (14 units a week).
- Exercise. Vigorous exercise has more impact than moderate exercise on raising HDL and lowering LDL, but whatever you are able to do will have a benefit.
Ideally HDL cholesterol levels should be over 1 mmol/L for men and over 1.2 mmol/L for women.