Possible side effects of statins
What alternatives are there to lower cholesterol?
Why have I been prescribed statins?
Statins reduce the amount of cholesterol in our blood, and reduce the risk of having a heart attack or stroke if you have already had one.
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If you have high levels of cholesterol, or have a family history of cardiovascular disease, and so are at risk of cardiovascular disease, your doctor will probably prescribe statins to lower your risk.
Familial hypercholesterolaemia means that, regardless of your lifestyle, you have high cholesterol levels.
Statins may also prescribed for people who have an inherited condition, familial hypercholesterolaemia (FH), which means that regardless of your lifestyle, you have high cholesterol levels.
Heart attack, stroke and peripheral arterial disease are collectively known as cardiovascular disease (CVD), which causes one third of all deaths in the UK. The National Institute for Health and Care Excellence (NICE), has draft guidance out at the moment, recommending reducing the threshold for prescribing statins from those with a 20% risk to those with a 10% risk. This will mean that millions more people may be prescribed statins by their GPs.
What the experts say about statins
However, in an open letter to NICE, experts including Royal College of Physicians president Sir Richard Thompson and Professor Clare Gerada, Past Chair of the Royal College of General Practitioners and Chair of NHS Clinical Transformation Board, asked NICE to reconsider this proposal. They say their concerns focus on six key areas:
- medicalisation of healthy individuals
- true levels of adverse events (side effects)
- hidden data
- industry bias
- loss of professional confidence
- conflicts of interest
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, responded to the open letter by saying: “The draft guideline does not propose that statins should be used instead of the lifestyle adjustments that people at risk of cardiovascular disease need to make - such as stopping smoking, being more active, drinking less alcohol, eating more healthily and losing weight.
“It encourages GPs to fully explore with their patients the ways in which people can reduce their risk of cardiovascular disease, presenting all the options promoted by the draft guidance, including lifestyle changes, blood pressure control, avoidance of diabetes and cholesterol (lipid) lowering, and to allow patients to make their own decisions.
“The independent committee of experts found that if a patient and their doctor measure the risk and decide statins are the right choice, the evidence clearly shows there is no credible argument against their safety and clinical effectiveness for use in people with a 10% risk over ten years. Because the price of statins has fallen, it is also cost-effective to use them to reduce the risk of cardiovascular disease at a lower threshold than NICE has previously recommended.”
“If you look at the research, and the clinical trials, you can see that statins are remarkably safe, effective, and pretty well tolerated by most people,” says Linda Main, Dietetic Advisor for the HEART UK, the cholesterol charity. “They are clinically proven to prevent heart attacks. But with so many millions of people taking statins in the UK, there are going to be some who are intolerant to them.”
NICE's response to the open letter
Being intolerant of these drugs can mean that you experience uncomfortable or painful side effects, which could include
So what can you do if you are at high risk of CVD, or have already had a heart attack or stroke, and statins don’t agree with you? There are a number of different statins, so it’s worth talking to your GP about perhaps trying a different one.
Another alternative is to reduce your cholesterol levels by changing your diet and lifestyle. “If your risk is high enough that you really should be on a statin, then you should talk to your GP,” says Linda Main. “Do this before you stop your medication. Changing your diet and lifestyle may help you to lower your dose of a statin so bringing unwanted side effects to manageable levels, but if you stop taking the statin altogether, do it in an informed way, and know what the risks are.”
You need to be realistic about what these lifestyle changes involve. You have to be determined to carry them through, and to stick with them. Even if you can do this, these changes are unlikely to make as much difference to your cholesterol levels as taking statins.
“If you had a very unhealthy diet and lifestyle, and were able to make all of the necessary changes, you could probably only reduce your cholesterol by about 25-to-30%. If you were taking the highest potency statin at the highest dose, you could reduce your cholesterol by about 60%.” Linda Main.
“If you had a very unhealthy diet and lifestyle, and were able to make all of the necessary changes, you could probably only reduce your cholesterol by about 25-to-30%. If you were taking the highest potency statin at the highest dose, you could reduce your cholesterol by about 60%,” says Linda Main.
The lifestyle changes you will need to make include stopping smoking. Smoking reduces your levels of good (or HDL) cholesterol, and makes your cholesterol stickier, so more likely to glue onto your artery walls. About 20% of heart disease deaths are directly attributable to smoking, so if you smoke, it’s time to stop. There’s lots of advice and help around to help you quit, so talk to your GP, your pharmacist, or go online at www.nhs.uk/smokefree.
Being more active
Being more active will help increase your HDL (good) cholesterol levels and bring down your LDL (bad) cholesterol levels. It can also lower your blood pressure, help reduce your body fat, and help you keep to a healthy weight and shape, and reduce your stress and anxiety levels.
Aim for a minimum of 2½ hours of moderate intensity exercise each week (so 30 minutes, five days a week). If you can be active for longer than this, you should see greater health improvements.
For a healthy heart you should do aerobic exercise, such as:
(If you haven’t exercised for a while check with your GP first.)
Eat for a healthy heart and body
These steps are good for your overall health, not just for your heart. And the same goes for the changes to your diet. HEART UK has its own cholesterol-lowering plan, called the Ultimate Cholesterol Lowering Plan – UCLP* for short. It is a step-by-step process for getting your cholesterol down.
“We start by talking about motivation, and getting people to focus on why it’s important to get cholesterol levels down,” says Linda Main.
“So we look at what their triggers are for eating unhealthy food. Then we look at the basics – lowering saturated fats in the diet, replacing it with healthier fat, and including high fibre carbohydrates or whole grains, at least five portions of fruit and veg a day, and one portion of oily fish a week.”
The third stage is looking at cholesterol-busting foods. These include:
- plant sterol and stanol fortified products – spread, yogurt and milk (read the labels)
- foods rich in soluble fibre, for example, oats and barley, vegetables such as aubergines and okra, and fruits such as apples, citrus fruits and berries
To find out more about UCLP*, and to download leaflets, go to http://heartuk.org.uk
*(this has been produced in collaboration with Alpro UK).
Other useful websites
British Heart Foundation
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