Statin tablets for high cholesterol- friend or foe?

Statin tablets for high cholesterol- friend or foe?

It is estimated that over one half of Irish people over 50 are supposed to be taking cholesterol lowering medications, namely statin tablets, having been prescribed them by their Doctor. However, we know that, on average, less than half of these patients take these tablets regularly! Why is this the case and who is correct- those who take them or those who don’t?

I frequently hear patients tell me, “I don’t feel unwell and now I am taking a tablet every day…shouldn’t tablets only be for people who feel unwell?” And on top of this, they may experience a side effect and get doubly frustrated, “I didn’t feel unwell in the first place and now I am taking a tablet which is making me feel unwell, so what’s the point?!” These are all very reasonable questions to ask, and generally reflects poor communication on our part.

But the answer is this. We do not take these tablets to feel better. We take these tablets to reduce our chances of a heart attack or stroke in future. Statins lower your cholesterol but they also stop pieces of plaque in your heart arteries from breaking off and precipitating a heart attack. They are not perfect however and can cause side effects. For some people they can cause muscle pains and cramping. But you have to remember, we can only prescribe any medicine when we know that the potential benefits outweigh any potential side effects. You may get a side effect on a statin but the side effect of not taking your cholesterol tablet regularly may tragically be an early heart attack.

It is reasonable to assume that in life, 50% of your future health depends on luck but 50% also depends on the decisions you make yourself. If you control everything in life that you can control, like your cholesterol, you are still relying on a certain amount of luck. However, if you don’t control these variables, you are stacking the odds greatly against you. This might not be fatal but it means that you are relying more and more on good luck!

So, who should be taking a statin tablet? It is a no brainer to be on these tablets if you have established cardiovascular disease (e.g previous stroke or heart attack), very high LDL (“bad”) cholesterol and most people with diabetes.

If you don’t fall into these categories but have slightly high LDL (“bad”) cholesterol, what we do in 2018 is make a decision for you based on your percentage chance of a heart attack, typically over the next 10 years. If your percentage chance is less than 5%, you do not need a tablet. If your risk is greater than 5%, you need to have a discussion with your Doctor about the possible benefits to your health of starting a statin. We will consider your own individual circumstances that may tip the balance in favour of either side.

Thankfully, modern technology also has a role to play and if we are still unsure, the latest international guidance recommends getting a simple CT scan of your heart to accurately estimate your “calcium score”. This test clarifies definitively your risk of developing heart disease by estimating the amount of calcified plaque in your heart arteries.

Statins are not the most important medicine we have. The most important medicine we have is exercise! Do this and constantly try to improve your lifestyle choices and you are doing about as much as you can. But for some people, statins are potentially the crucial health choice to finally tilt the odds in their favour.