Q&A: Should I start taking statin tablets?

Questions:

When should a person think of taking statin tablets in your opinion? I know doctors have very different views on it

-Lana

Answer:

Dr Sarah Jarvis says: “The vast majority of doctors believe that everyone who has had a heart attack or stroke, and the vast majority of people who have type 2 diabetes, should be taking a statin tablet regularly unless there’s a medical reason why they shouldn’t.

There has been huge debate on the risks and benefits of statins for other patients - there is no doubt that they reduce the risk of heart attack and stroke even in healthy people, but these are ‘relative’ reductions in risk. So if your risk is already tiny, cutting even by ¼ won’t make a big difference in real terms.

Like all medicines, statins have side effects. Many people will get short-term side effects, including wind, bloating and diarrhoea. These tend to settle within weeks, but a smaller number of people get muscle aches and pains. A few find that statins have a severe negative effect on their memories, but this needs to be weighed against the fact that statins protect against the second commonest cause of dementia, vascular dementia, so some people may have better memory in the long term if they’re on statins.

The problem with statistics is that they can be used to ‘big up’ or minimise benefits, depending on how you look at them. So for instance, many people opposed to statins use the statistic that on average, they only increase the life expectancy of healthy people by a few days. In fact, this is an average – they won’t make any difference to many people’s life expectancy, but some people may live many years longer as a result. We have no way of knowing which patients will avoid a stroke as a result of taking them.

Until last year, NICE (the National Institute for Health and Care Excellence) recommended that everyone should have their 10-year risk of heart attack and stroke assessed regularly over the age of 40. This takes into account age, gender, smoking status, blood pressure etc as well as cholesterol. If this risk was over 20%, they should be offered a statin. Last year, they changed this threshold to 10%

If I look at a patient’s 10-year risk of heart attack and stroke and discover they’re at ‘borderline’ risk, I always try to discuss with them the non-drug options they can take. Even if many patients can take medicines like statins with no side effects, most doctors would much prefer people to improve their lifestyle instead. Stopping smoking is an obvious ‘easy win’ for your heart as well as your lungs and much else. So is losing weight if you’re overweight. But for cholesterol specifically, the portfolio diet offers great all-round improvements for your heart, bowels and levels of micronutrients.

If my risk was over 10%, I’d certainly look to see if I could improve it without tablets. If I couldn’t, would I take a statin regularly? Yes, absolutely.”

-Dr Sarah Jarvis