FAQs: Cholesterol and statin therapy
What is cholesterol?
Cholesterol is a fatty substance found in your blood. High levels of cholesterol can lead to fatty deposits building up in your arteries which increase the risk of cardiovascular disease and can lead to angina, heart attack and stroke.
Cholesterol is carried in your blood by proteins. When the two combine, they’re called lipoproteins.
The two main groups of lipoprotein are:
- High-density lipoprotein (HDL) carries cholesterol away from the cells and back to the liver, where it’s broken down or passed out of the body as a waste product. For this reason, HDL is referred to as good cholesterol, and higher levels are better.
- Non High-density Lipoproteins (non-HDL) which includes Low-density lipoprotein (LDL), very low density lipoproteins (LDL), and others. These carry cholesterol to the cells that need it, but if there’s too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries. For this reason, non-HDL cholesterols are known as bad cholesterol, and lower levels are better.
The amount of cholesterol in the blood (both HDL and non-HDL) can be measured with a blood test.
What causes high cholesterol?
Anyone can develop high cholesterol. It can be caused by many different things; some you can control, and others you can’t.
Things that cause high cholesterol which you can control:
- Eating too much saturated fat
- Being physically inactive
- Smoking: this can lead to high cholesterol levels and it causes tar to build up in your arteries, making it easier for cholesterol to stick to your artery walls.
- Drinking large amounts of alcohol
Things that cause high cholesterol which you can’t control: your age, biological sex, genetics, and ethnic background
- Getting older: higher cholesterol is more likely as we age
- Biological sex: if you were assigned male at birth you are more likely to have high cholesterol
- Ethnic background: if you are south east from South Asian background you are more likely to have a high cholesterol
- Genes: Genes carry the information that determines your features or characteristics that are passed on to you — or inherited — from your parents.
- Familial hypercholesterolaemia(FH), is an inherited condition, meaning you were born with it. It is often passed down through families in faulty genes and can lead to very high levels of cholesterol, even if you don’t have other risk factors
There are also certain health conditions that can be associated with higher cholesterol levels: kidney disease, liver disease, diabetes, hypothyroidism (untreated). If you have one of these conditions you may be offered lipid lowering therapy even if you don’t have other risk factors.
Why do I need to lower my cholesterol?
Cholesterol is essential for your body to work well, but too much ‘bad cholesterol’ is unhealthy. High levels of ‘bad cholesterol’ in your blood can lead to fatty deposits building up in your arteries. This can increase your risk of developing cardiovascular disease, which includes conditions such as coronary heart disease (leading to angina and heart attack) and stroke.
Reducing your levels of “bad cholesterol” has been shown to reduce the risk of heart disease and stroke.
Is there an ideal target for my cholesterol?
There are several recommendations on the optimal cholesterol levels, depending on your medical history and other risk factors for heart disease and stroke. This can cause confusion and concern to people, as there is no “one size fits all”.
However, the most important thing when you are prescribed a statin is that you are taking it regularly and that your high level of cholesterol is decreasing. Your GP will evaluate your cholesterol levels on an annual basis, taking into account your other risk factors and medical history. If they see that you are not reaching the optimal cholesterol levels for your specific situation, then they will discuss adjusting your statin dose, or adding in additional therapies.
A common cause of patients not having a significant or sustained reduction in their cholesterol levels is not remembering to take their statin medication regularly, or not taking it at all. Statins work best if taken long term. For further information on cholesterol levels see https://www.nhs.uk/conditions/high-cholesterol/cholesterol-levels/
How can I improve my cholesterol levels without medication?
You can help to lower your cholesterol by eating a healthy balanced diet, taking regular exercise, stopping smoking, and maintaining a healthy BMI and waist circumference. These measures are an important part of improving your heart health. However, it is difficult to significantly reduce cholesterol levels by diet alone, which is why medication, particularly statins, are often recommended.
What are statins?
Statins are a group of medicines that can help lower the level of “bad” low-density lipoprotein (LDL) cholesterol in your blood, and protect the insides of the artery walls.
Statins reduce the production of LDL inside the liver.
Statins can reduce the risk of heart disease and stroke by a third if taken properly and at the right dose. Statins come as a tablet that are taken once a day.
Statins are one of the most researched medicines in the world and there is very strong evidence that they help reduce the risk of cardiovascular disease. Statins are most beneficial when you take them on a long-term basis.
Are statins safe?
Statins are one of the most well researched types of medicine, with studies repeatedly showing very strong evidence that they are a very safe way to help prevent heart disease and strokes. In fact, statins, if taken regularly over a long period, reduce the risk of stroke and heart attack by up to a third.
Are there any side effects?
Statins are among the safest and the most studied medications available today
Most people don’t have any side effects when they take a statin and most take them every day without any problems.
Side effects can occur with all medications, and the most frequently reported side effects of statins are muscle aches and pains. However this side effect is actually uncommon, affecting only one in 500 patients each year.
It is sometimes difficult to know if muscle aches and pains are linked with taking a statin or with general day-to-day life. Usually, stopping the statin for a few days under supervision from your doctor will show you if it is actually the statin.
A research study suggested that in very rare cases statins may increase your risk of developing type 2 diabetes, but still resulted in clear overall benefit by reducing the risk of heart attacks and strokes.
If you do experience side effects, or if your side effects change or become worse, tell your GP, who can discuss things with you, and if necessary change your statin or dose.
Statins target the liver cells where cholesterol is made. Before you start taking statins, you might have a blood test to check how well your liver works. Your doctor may request that you have a follow-up blood test a few months later. If your liver is affected, your doctor may want to reduce your dose or change your statin to another kind of medication that lowers your cholesterol.
Do I have to avoid certain foods if I am on a statin?
You can check the patient information leaflets that is supplied with your medications. If you have further questions, you can check with your pharmacist. If you’re taking Simvastatin, avoid grapefruit and grapefruit juice as they can increase your risk of side effects. If you’re taking atorvastatin, the occasional glass of grapefruit juice is thought to be fine, but large amounts are best avoided (more than 1.2 litres per day). Currently, healthcare professionals advise it is safe to drink grapefruit juice and eat grapefruit if you’re taking other types of statins.
Are there any alternatives to statins?
Statins, when taken correctly are the most effective way to lower cholesterol levels, and have been shown repeatedly to reduce the risk of heart disease and stroke. They are safe, effective and widely available, which is why they are the first line treatment for lowering cholesterol.
You can also help to lower your cholesterol by eating a healthy balanced diet, taking regular exercise, and maintaining a healthy BMI and waist circumference. These measures are an important part of improving our heart health. However, it is difficult to significantly reduce cholesterol levels by diet alone.
Other medications are now available to help lower cholesterol levels in people for whom statins are unsuitable or not tolerated. They can also be used in combination with statins to achieve better cholesterol control, if statins alone are not sufficient. These medications (including statins) are collectively referred to as “Lipid lowering agents”.
If your cholesterol is not to target despite regular statin use, your GP may advise adding in a second lipid lowering agent.
Why is there so much bad press about statins?
It’s not possible to say for certain why the media sometimes suggest statins are bad. Statins are one of the most well researched types of medicine, with studies repeatedly showing very strong evidence that they are a safe way to help prevent heart disease and strokes. Side effects are rare. Even one of the more common side effects, muscle pain, is rare. If you have any concerns you can speak to your GP, nurse or pharmacist.
My GP wants to put me on a statin – do I have a choice?
It is extremely important that both you and your GP (or healthcare professional) have an honest discussion about any medication and why it is being suggested. You should ensure you are clear on the benefits and risks and that you understand what is being said. You should never be frightened to ask questions.
Initiatives such as Me & My Medicines can help you with these conversations. To find out more about this initiative please visit https://meandmymedicines.org.uk/
I don’t know if my cholesterol is high – how do I find out?
If you’re in the 40-74 age group without a pre-existing condition, you can expect to receive a letter from your GP or local authority inviting you for a free NHS Health Check every five years.
The NHS Health Check is a free check-up of your overall health. It can tell you whether you’re at higher risk of getting certain health problems. One of the tests they do is check your cholesterol https://www.nhs.uk/conditions/nhs-health-check/nhs-health-check/
If you are not aged between 40-74 and your GP has not spoken to you about your cholesterol and you are still worried, for example if you know you have a family history of high cholesterol, speak to your GP (or healthcare professional).
Why I am changing statin?
Evidence has shown that people taking more effective statins, in particular Atorvastatin, enjoy additional benefit compared with those people taking less effective statins such as Pravastatin, Fluvastatin, or Simvastatin.
Therefore, national guidance from NICE recommends that people on less effective statins should have their prescriptions reviewed.
It is important to offer patients the best available medication to reduce their future risk of developing Cardiovascular disease (CVD).
Your doctor will be reviewing your treatment and may recommend switching to a more effective statin (e.g. Atorvastatin) to reduce your risk of CVD.
Changing statins shouldn’t cause you any additional side effects. However, if you are concerned we recommend that you discuss this with your pharmacist.
When starting a new statin, a routine blood test is advised after three months. You can arrange this with your GP in the usual way. This should demonstrate that your cholesterol level is lower than on your previous treatment.
Where can I find out more information?
You can find out more information about statins and why it is important to lower bad cholesterol on the Heart UK website
Other websites that provide good quality information are:
If you have further questions about statins and a healthy lifestyle, you can also talk to your pharmacist, practice nurse or GP. Your local pharmacy can provide some useful information about what statins are and answer any basic questions.
For local information and support you can look at https://www.hantsiowhealthandcare.org.uk/healthy-hearts