Preventive pills: key facts to know
When I first became a GP, most of the medicines I prescribed were to treat symptoms, not to stop people getting them. But these days we have a host of medicines designed to keep you in good health, even if you feel fine.
Even though cardiovascular disease - heart attack and stroke - is still the UK's biggest killer, we have almost halved death rates from it in little over 20 years. Much of the credit for that must go to the preventive medicines so many of us take every day.
We know it's hard to remember to take tablets every day - and even harder if they don't serve an immediate purpose, like relieving pain. But it is important to take prescribed medicines regularly. If you're getting side effects from them, speak to your GP rather than stopping them. And if you have trouble remembering all your tablets, your pharmacist may be able to help by providing a 'dosset box' to organise your pills or even packaging them up weekly for you.
Never has one small tablet caused so much confusion. Twenty years ago, we discovered that if you'd had a heart attack or stroke, taking 75 mg (a quarter of a full-strength aspirin tablet) cut your risk of another one by almost 25%. Doctors started recommending lots of people take 75 mg aspirin a day - until we realised that the risks of internal bleeding from aspirin might outweigh the risks for some people. New guidance from the National Institute for Health and Care Excellence (NICE), suggests that people with type 2 diabetes shouldn't take aspirin regularly either, unless they've had a heart attack.
Now it seems that taking the same dose for five to 10 years from your early 50s could cut your risk of dying from cancer of the colon or stomach by over a third. But at the same time, new guidelines advised aspirin shouldn't be used for people with a common abnormal heart rhythm called atrial fibrillation - they should take warfarin or similar blood-thinning medicine instead. If you've had a heart attack or stroke, you should take 75 mg aspirin a day for life. Otherwise, speak to your GP about your personal risks and benefits.
Statins cut your risk of heart attack or stroke - it's a fact. Until last year, national guidelines also recommended statins for anyone with a one in five chance of having a heart attack or stroke in the next 10 years (based on your age, gender, blood pressure, cholesterol levels etc). Now they're recommended if your 10-year risk is more than one in 10. This move has been controversial - in real terms, a lot of people at this level of risk will have to take statins to stop one of them getting a heart attack. What's more, statins (like every other tablet) cause side effects in some people, with muscle aches being perhaps the most troublesome where statins are concerned.
If you've had a stroke or heart attack (and usually if you have type 2 diabetes) your doctor will strongly recommend you take a statin for life. If not, some healthy lifestyle choices could cut your risk enough for you to forget your statin!
These tablets used to be used widely to treat high blood pressure - now we have more effective alternatives. But they're still recommended long-term if you've had a heart attack, heart failure, or some abnormal heart rhythms.
Proton pump inhibitor
Do you take a regular medicine for heartburn or indigestion, with a name ending in '-azole' (omeprazole, lansoprazole etc)? If so, like millions of other Britons, you're taking a proton pump inhibitor or PPI. Some people take the odd tablet when they get a bout of indigestion; others take them regularly to keep heartburn at bay. If you've taken a PPI for years and haven't had any indigestion, your doctor may recommend trying to tail them off. If you're taking some medicines like anti-inflammatory painkillers (ibuprofen etc) your doctor may recommend you take a PPI as long as you're taking the anti-inflammatory, to reduce the risk of stomach inflammation.
Can I help myself?
Some risk factors for heart attack and stroke - like getting older - you can't change (apparently ignoring your birthdays doesn't count!). But some will make a huge difference. Smoking is the (very) obvious one; but keeping your weight in the healthy range,exercising regularly and eating a heart-healthy diet will all help. With regular weight-bearing exercise and plenty of calcium in your diet you're less likely to need tablets to prevent worsening osteoporosis (thinning of the bone); and by avoiding excess alcohol and spicy foods indigestion may be a thing of the past.
With thanks to 'My Weekly' magazine where this article was originally published.