Statins – not a ‘one size fits all’ cholesterol antidote

This week’s health news headlines suggest everyone over the age of 50 should be put on a statin automatically. I don’t think this is the best way to deal with the problem of raised cholesterol. That’s not because I don’t believe in statins – they are extremely effective at lowering cholesterol, and therefore cutting your risk of heart attack and stroke.

However, all medicines carry risks as well as benefits, and as a doctor I weigh up these risks and benefits every time I prescribe a medicine. If you’re otherwise healthy and not on other medicines, there’s a good chance that you won’t have any side-effects, but up to one in 10 people taking statins get minor side-effects and a far smaller number get severe ones.

If you don’t have any other risk factors for heart attack or stroke except being over 50, you won’t get nearly as much benefit from a statin as someone at high risk but you’re just as likely to get side-effects. That means the risk-to-benefit ratio is far less strongly weighed on the benefit side.

The study suggesting this strategy argues that a ‘blanket’ policy would be easier and cheaper, and possibly more effective, than the present policy of screening everyone over 40. The point about screening is that if you find someone is at high risk, it gives you the opportunity to give them advice about healthy lifestyle changes to lower their cholesterol. A ‘fire and forget’ policy for everyone doesn’t.

I would much rather see everyone over the age of 40 having a full assessment of all their risks, including cholesterol, blood pressure, smoking, gender and weight. National guidelines suggest we should be considering statin treatment for anyone with a 10-year risk of heart attack or stroke that’s higher than 20%. I have 35-year-olds with a higher risk than this, because they smoke and are obese; and 60-year-olds whose 10-year risk is half this. That’s why I don’t believe a ‘one size fits all’ approach is the best way forward.

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