NICE Lipid Modification Guidance has been revised to enable doctors to offer statin treatment to people at lower 10 year risk but high lifetime risk of CVD. See our responses to the questions this raises.
Good evidence shows that improving your blood cholesterol level can reduce your risk of cardiovascular diseases (heart attacks, strokes or angina). There are many ways to lower cholesterol such as following a cholesterol-lowering diet including reducing your intake of saturated fat and eating more cholesterol busting foods, combined with being physically more active. Stopping smoking and managing high blood pressure are also important in reducing cardiovascular risk.
However, for many people lifestyle changes on their own, are not enough and treatment with a statin, the main type of cholesterol-lowering drug, is required to ensure that high cholesterol levels, and heart disease risk, are reduced sufficiently.
Are there side effects from statins?
There is a huge amount of clinical evidence indicating that the benefits of taking a statin are substantial. Added to this they are well tolerated, the risk of side effects from statins is low and serious adverse effects are rare.
How do statins work?
Statins work by slowing down the production of cholesterol by the liver. They do this by interfering with the action of a key enzyme, HMG-CoA-Reductase. Cholesterol production is not fully blocked nor is the production of other substances that are derived from the same pathway, such as steroid hormones and vitamin D.
Because cholesterol synthesis is reduced, the liver takes up more cholesterol carrying LDL particles from the blood. The net result is a reduction in circulating LDL-cholesterol (bad cholesterol).
Statins also help to stabilise the fatty plaques (fatty deposits or atheroma) within the lining of the arteries. This is why people who are at high risk of heart disease or stroke or who have diabetes, may be prescribed a statin even if they have a normal cholesterol level.
How quickly can statins lower cholesterol?
For most people a good cholesterol reduction will be achieved within four-weeks of starting a statin. However, although they work in the same way, they have some differences. Statins vary in:
- their potency
- their maximum cholesterol-lowering ability
- the doses in which they are prescribed
- the way in which the body breaks them down
The average LDL-cholesterol reduction from a statin is around 29% but can be as high as 50%.
The most commonly prescribed statins in the UK are atorvastatin and simvastatin. Other statins include fluvastatin, pravastatin and rosuvastatin.
How long do I have to take a statin?
Once you have been prescribed a statin, it is important to continue to take it every day in order to keep your cholesterol low and reduce your risk of future health problems. If for any reason you are unable to continue to take your statin you should speak to your GP as soon as possible.