Essential facts to consider when using statins for cholesterol reduction
In the fight against heart disease, a leading cause of death worldwide, statins have proven to be a crucial tool in primary prevention. These cholesterol-lowering medications are prescribed by doctors to help reduce the risk of heart attacks and strokes.
The National Institute for Health and Care Excellence (NICE) reported that around 5.3 million people in England had taken statins or the cholesterol-lowering medication ezetimibe in the previous year. The use of statins is increasing globally, and they are available on prescription in the UK, with five statins to choose from. Atorvastatin, considered the best, can be given in doses ranging from 10-80mg per day, and side effects tend to be dose-related.
The decision to start taking statins should be based on an individual's overall risk of heart disease. Doctors use a personal cardiovascular risk score to calculate this, which tells how likely a person is to have a heart attack or stroke in the next ten years. Guidelines commonly suggest considering statins for people with a 10-year cardiovascular risk above certain cutoffs—for example, ≥7.5-10% (borderline to intermediate risk) or ≥20% (high risk).
Even within intermediate risk groups, factors like elevated LDL cholesterol, apoB levels, or non-HDL cholesterol may push toward starting statins. Other risk enhancers like diabetes also influence decisions. The risk score initiates a conversation between patient and clinician about statin therapy, balanced against lifestyle changes and patient preferences. For lower risk levels, lifestyle modification may be preferred initially, with reassessment over time.
Researchers have pulled together results of hundreds of clinical trials to strengthen the evidence for statins' effectiveness. Statins reduce low-density lipoprotein (LDL) cholesterol, often referred to as the 'bad' type that clogs up arteries, and have been shown to reduce the relative risk of vascular events by around 38% in intermediate-risk patients. However, absolute risk reductions can be modest, making personalized risk estimates important to weigh treatment benefits against possible side effects.
If a person experiences side effects from statins, they should discuss with their doctor the possibility of adjusting the dosage or changing the type of statin prescribed. A 2021 study suggests that side effects from statins may be more related to negative associations with taking a pill than the medication itself.
It's important to note that liver, kidney, and eye problems were even less common among statin users. People with diabetes may be concerned about new research showing that statins can raise blood sugar, but the beneficial effects of lowering cholesterol are thought to outweigh the harmful effects of slightly increased blood sugar. Anyone taking statins should have regular blood tests to check for potential liver and kidney problems.
In conclusion, the cardiovascular risk score quantifies the patient's risk to guide whether statins are likely to provide meaningful preventative benefit, facilitating personalized and evidence-based statin initiation decisions through clinician-patient discussion. This aligns with guidelines emphasizing both absolute risk thresholds and patient context in statin prescribing for primary prevention.
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