New recommendations say more of us should take statin drugs to lower cholesterol, says Dr Melanie Wynn-Jones
Statin prescriptions have tripled in just 10 years, but NICE, the National Institute for Health and Clinical Excellence says that lowering the threshold could save 8,000 more UK deaths a year from cardiovascular diseases (CVD – heart attacks, strokes, kidney damage, circulatory problems and possibly dementia).
Cholesterol – good and bad
Our bodies use cholesterol (a form of fat) to make cell walls and vital hormones; we manufacture it in our livers and absorb it from food. It circulates in our blood as HDL and LDL-cholesterol (high and low-density lipoproteins).
People with raised total or LDL-cholesterol levels are more likely to develop CVD (narrowed arteries linked to cholesterol-containing deposits that reduce or cut off blood flow), although HDL-cholesterol (‘good’ cholesterol) may help to protect us.
UK recommended total cholesterol levels are 5mmol/l or below, with LDL-cholesterol levels of 3mmol/l or below (usually measured after an overnight fast), but the targets are 4mmol/l and 2mmol/l if you already have CVD or diabetes, or are at high risk (see primary prevention below).
Our genes and lifestyle (see ‘5 Ways To Lower Cholesterol Levels’, below) mean many of us exceed these levels; medical conditions such as hypothyroidism (underactive thyroid) and kidney damage, and some medicines such as diuretics (‘water tablets’), the contraceptive pill and some breast cancer drugs can raise them, too.
When are statins recommended?
Simvastatin, atorvastatin, fluvastatin, pravastatin and rosuvastatin lower total and LDL-cholesterol levels and may reduce inflammation, too. Recent US research suggests some statins may also reduce post-menopausal women’s risk of dying from cancer by a fifth (and reduce men’s risk, too).
You’ll almost always be offered a statin if you have existing CVD or diabetes (secondary prevention). You may also be offered a statin if a cardiovascular risk assessment suggests your risk of developing CVD in the next 10 years is greater than 10% (primary prevention).
This assessment, for example, such as the free NHS health check for people aged 40-74 years, also takes raised blood pressure, family history and lifestyle into account, and NICE has just lowered the threshold from 20%, despite protests from GPs worried about costs, and unnecessary side effects in low-risk patients.
Recent French research suggests primary prevention could cut strokes (but not heart attacks) by 30% in healthy older people.
Monitoring and side effects
Muscle pains are common, but there’s a small risk of severe muscle damage; you’ll need an urgent blood test, and may need to stop/switch statins.
Liver damage is another rare side effect, and you’ll need blood tests for the first year, but report any upper tummy pain, nausea or jaundice (yellow skin/eyes) immediately. If you’re taking statins for secondary prevention, you’ll need checks to see if you’ve reached the target, but not for primary prevention, as taking the statin is considered sufficient.
Statins may also increase your risk of developing diabetes by almost half, so you may need a blood-sugar check, too. The list of other reported side effects is huge, and includes headaches, sleep disturbance and nightmares, memory problems, and digestive upset – tell your GP, who may suggest stopping or switching your treatment.
Occasionally, additional or alternative drugs (ezetimibe or a fibrate medication) are needed.
5 ways to lower cholesterol levels
1. Eat fewer saturated/trans fats and more unsaturated fats (oils, nuts, seeds and oily fish).
2. Eat more soluble fibre, such as oats, pulses, fruit and vegetables.
3. Take 30 minutes of vigorous exercise five times a week.
4. Drink alcohol only within recommended limits.
5. Maintain a healthy weight (keep your waist measurement lower than half your height).