All you need to know about.. STATINS
Your guide to controversial drugs’ ups & downs
Statins are significantly overprescribed for low-risk patients, a study suggests. Yet just 35% of people who should be on the drugs – at high risk of cardiovascular disease, heart attack and stroke – actually take them.
Where are we going wrong? What do you need to know and when should you ask your doctor about being on statins or coming off them? Dr Ellie Cannon answers the essential questions.
1 How do statins work?
They are drugs that cut the amount of cholesterol in the body. About half of your cholesterol is actually made in your liver (not from your diet) and statins directly stop that process. They also improve the balance between good and bad cholesterols in the blood.
2 Who should be on statins?
The main reason to prescribe statins is to reduce a person’s risk of cardiovascular disease (CVD), heart attacks and strokes. Reducing cholesterol lowers risk.
Statins are prescribed in two main situations. Firstly, if you have a family tendency to high cholesterol, called familial hypercholesterolaemia. This is when your body makes too much cholesterol and puts you at risk of CVD.
Secondly, if you are at high risk for other reasons – for example if you are diabetic, you’ve had a heart attack before, or you have a combination of other risk factors such as high blood pressure, angina, obesity and smoking.
The National Institute for Health and Care Excellence recommends those with a 10% or higher chance of developing CVD within 10 years should be offered them.
If you have high cholesterol but no familial problems, and are not high risk for other reasons – for example, if you have type 2 diabetes – you’d usually be given the chance to try to reduce cholesterol without statins through dietary changes and losing weight.
3 What are the benefits of taking statins?
Statins show particular benefits when people who have had a heart attack or stroke take them – they are good at preventing repeats. For every 1,000 at risk of heart problems, if those people take a statin for three years, the drugs will prevent seven non-fatal heart attacks, four strokes and two deaths. As there are 17.5 million in the UK at risk of heart problems, thousands of heart attacks, strokes and deaths could be prevented.
4 What is the risk of developing Type 2 Diabetes when on statins?
There is no clear, proven link. In studies, it is hard to separate between those who develop high blood sugar as a result of taking the tablets and those who would have developed it anyway.
A person likely to have high cholesterol may also be likely to develop type 2 diabetes, regardless of whether they are on statins. Type 2 diabetics are usually recommended to be on a statin.
5 Is there a link between statins and cancer?
There is no proven link and there may be some trials that show they reduce your chances of cancer. A study in China showed a reduction in deaths from breast cancer in women on statins.
6 What about statins causing muscle aches and pains?
Statins are known to cause muscle pains and it is thought one in 10 people may get them on a statin.
However, the actual number of people affected with this side effect is overplayed and a recent research study showed that patients who were unaware that they were taking statins did not complain of muscle pains.
But when the same patients were told the drug they were on was a statin, they were more likely to report aches and pains.
7 Can I refuse to go on statins – and what would you say to me if I did?
Of course. You can refuse any medicine offered. Prescribing medicine is always a partnership between doctor and patient, and we only want to give you things you are comfortable with.
If you refuse a statin after understanding why you have been recommended one, I would hope a GP would give you other advice: how to lower your cardiovascular risk factors through diet and exercise, and on quitting smoking and avoiding type 2 diabetes.
Cardiovascular risk comes from many different factors such as obesity, smoking and blood pressure as well as family history. If we can’t treat the cholesterol, we can try and reduce other risk factors.
8 If I go on statins, will I have to be on them forever?
Absolutely not. All medicines are subject to review and you and your doctor may decide to change course. If you undergo a strict diet or exercise regime, for example, statins may no longer be necessary. On the other hand, if you inherited a very high cholesterol, lifelong statins may be necessary.
The guidelines are general rules for a majority, but each prescription should be decided for the individual. If you were having severe side effects, for example, it would not be appropriate to carry on.
9 Are there any alternative drugs to statins that could help me?
Yes, these are known as fibrates – such as ezetimibe. They are used if a statin is necessary but very badly tolerated – for example if you take a statin and get immobilising muscle pains or serious effects on the liver. They can be used as an alternative to lower your risks from cholesterol without the side effects a statin sometimes causes.
10 Are there alternatives to help lower risk of developing cardiovascular disease?
A range of factors can affect risk of cardiovascular disease. Some are non-modifiable – that is, we can’t change them. For example being Asian, being male and a family history of susceptibility all puts you at risk.
Other risks can be changed. You can take medication for high blood pressure, lose weight, eat healthily and up your exercise regime to lower cholesterol levels and reduce risk of type 2 diabetes.
Fundamentally, maintaining a normal weight and keeping active – along with not smoking – is a great way to keep your heart disease risk low.