Your doctor has offered to prescribe you statins to prevent cardiovascular disease (CVD) events such as heart attack and stroke. CVD describes a number of conditions and diseases that affect your heart and blood vessels. It’s caused by the narrowing of your arteries (atherosclerosis).
Statins are for people who have already got or have a history of CVD or who are currently healthy but are at risk of developing CVD.
If you have a history of CVD
Statins can help prevent the following from getting worse or from happening again if you have:
- already had a heart attack or stroke
- peripheral arterial disease – a disease that causes your arteries to become narrowed
- had a transient ischaemic attack (a ‘mini stroke’)
- high cholesterol
- type 1 or type 2 diabetes
- high blood pressure
If you have a genetic condition called familial hypercholesterolaemia (FH), you might also be offered statins. FH is an inherited condition where you have high level of cholesterol in your blood.
If you’re at risk of developing CVD
Statins can also help stop CVD from developing in people who are currently healthy but are at risk. Your doctor can assess your risk by asking you a series of questions and carrying out some health checks.
If your doctor thinks there is at least a one in 10 chance of you having a heart attack or stroke over the next 10 years, they may advise statins.
Your doctor may also look at your lifetime risk, as well as your 10-year risk. This is so that younger people who have a low 10-year risk but a higher lifetime risk can get the treatment they need earlier and can delay the potential onset of CVD.
Usually, before your doctor suggests taking statins, they will work with you to see how you can adapt your lifestyle to naturally lower your cholesterol level. If this doesn’t work or you can’t make changes for any reason, your doctor may offer to prescribe statins alongside these lifestyle measures. It’s still really important to continue with the lifestyle measures because they will give you benefits additional to those of the statin. Your treatment is very much a combined approach and it’s important not to rely solely on your medicine.
Statins work by lowering the amount of cholesterol in your blood.
Cholesterol is a type of fat made in your liver. It does a lot of important jobs that keep you healthy. However, if you have too much ‘bad’ cholesterol (low-density lipoprotein or LDL) in your blood, it can cause fatty deposits to build up on the walls of your arteries. This is known as atherosclerosis – it’s a condition that narrows your arteries.
Statins work by reducing the amount of LDL cholesterol your body makes. They do this by blocking an enzyme in your liver needed to produce cholesterol. This slows down the production of cholesterol by your liver. By reducing your cholesterol, statins can help to reduce your risk of having cardiovascular disease (CVD) events such as a heart attack or stroke.
History of cardiovascular disease (CVD)
There’s good evidence from large and well-conducted medical studies that show that if you have had a heart attack or stroke, taking statins can prevent you from having another one. They also reduce the chance of you having other cardiovascular problems and can prolong your life.
At risk of developing CVD
Research also shows that taking statins can reduce your risk of developing CVD and having a heart attack or stroke if you have no past or current history of CVD but are at risk. The National Institute for Health and Care Excellence (NICE) has produced a patient decision aid with diagrams that explains how well statins work for people in this scenario. It’s designed to help you be better informed so that you can make a decision about whether you want to take statins or not.
Take a look at the example below.
While it’s impossible to say what will happen to individual people, the following is a scenario that can help to explain the effect of taking statins on a group of 100 people.
In a group of 100 people who have a 10 per cent risk of developing CVD over the next 10 years and aren’t taking statins, 10 people will either have a heart attack or stroke and 90 of them won’t.
If the same group of people all took statins, then the same 90 people as before still won’t develop CVD. Six people of the remaining 10 will either have a stroke or heart attack. So four people will be saved from having either a stroke or heart attack, because they were taking the statin.
Have a look at the patient decision aid for more detail; it shows what the outcomes are for a 10 per cent risk over 10 years to a 40 per cent risk over 10 years.
Other benefits of statins
Besides lowering cholesterol, statins work in other ways which have beneficial effects on preventing CVD and other conditions. For example, statins can be beneficial if you have CVD and your cholesterol is normal. It’s thought that stains may have anti-inflammatory effects and may help strengthen and repair the walls of your blood vessels. They may help reverse atheroma (the fatty deposits that build up in arteries) and may reduce the risk of atrial fibrillation.
Making a decision
You don’t have to decide immediately – a few weeks won’t make a difference to most people. However, it’s thought that the sooner you decide, the sooner you’ll get the benefit from taking statins. Take your time to read information, talk to your doctor and your family. Weight up the pros and cons. Ultimately, the decision is yours so it’s important that you feel happy with it.
There are five types of statin:
- atorvastatin (e.g. Lipitor)
- fluvastatin (e.g. Lescol)
- pravastatin (e.g. Lipostat)
- rosuvastatin (e.g. Crestor)
- simvastatin (e.g. Zocor)
Your doctor will normally decide which statin to prescribe based on a number of factors including how effective it is and the cost. Most people are first prescribed atorvastatin. You can buy certain low-dose statins from a pharmacy without a prescription from a doctor. Your pharmacist will advise if these are suitable for you. However, if you’re at high risk of having a heart attack or stroke, your doctor will prescribe a higher-dose statin for you.
Statins are classed as low, moderate or high intensity, and you may wonder what this means. This classification is based on how much each statin reduces LDL cholesterol. This is calculated as a percentage. Low-intensity statins reduce LDL by 23 to 30 per cent; medium-intensity stations reduce LDL by 31 to 40 per cent; and high-intensity statins reduce LDL by 40 per cent or more. Most people start on a high-intensity statin but it depends on what your doctor thinks is best for you and your health needs.
You take statins as tablets or capsules and usually take them in the evening. This is when your liver produces cholesterol so the statins have a slightly better effect if you take them at this time. Some statins, such as atorvastatin, can be taken at any time of the day. But you should try to take your tablet at the same time every day. If you forget to take it, wait till your next dose – don’t take double. If you take too much, ring your doctor or hospital for advice.
How often will I need check-ups?
You are likely to have a check up at three months and then again after a year. Your doctor will check your liver function and your cholesterol level to see how well your medicine is working. At these stages, your doctor may change the type or dose of your statin, or even change to a different medicine to make sure you’re getting the right treatment for you.
Most people who are at risk of developing cardiovascular disease (CVD) start on 20mg of atorvastatin. Those who already have CVD usually start on 80mg of atorvastatin. It’s not always possible to get the dose right first time, so your doctor may change your dose if you have any problems.
Will I have to take statins for life?
Yes, you will need to take statins on a long-term basis, with ongoing monitoring. If you stop taking them, it’s likely you’ll stop getting the benefits. This is a big commitment and change to your lifestyle, so it’s important that you talk the pros and cons through with your doctor to make a decision you’re happy with. Your risk changes with your age and health so regular monitoring helps your doctor make sure the treatment is working for you as time goes on.
Statins aren’t the right treatment for everyone.
If you have liver problems or have a high alcohol intake, speak to your doctor before taking statins. This is because statins work through your liver. Your doctor will do a liver function test before you start taking statins. You won’t be able to take statins if you have liver disease.
If you have hypothyroidism, your doctor will treat this first because the medicines to treat it might correct your cholesterol levels without the need for statins.
If you’re pregnant or breastfeeding, you won’t be able to take statins because they may harm your baby. If you’re taking statins and would like to try for a baby, speak to your doctor first.
There is debate about whether or not statins are an appropriate treatment for older people, particularly those who are frail or taking medicines for other long-term conditions. This is because there may be an increased risk of falls, side-effects and problems with mobility. Your doctor will take these factors into account before prescribing statins for you.
Check with your doctor before you take any other medicines at the same time as your statin.
Medicines that may interact with statins include those that act on your immune system, certain antibiotics and certain types of medicine for your heart.
Don’t have grapefruit or grapefruit juice because it can interfere with the enzyme in your body that breaks down statins. This can increase the amount of the statin that is absorbed into your blood. A high concentration of a statin in your blood can make you more likely to develop side-effects, which can affect your liver and muscles.
Is it true that statins can have bad side-effects?
There have been lots of stories in the media about statins and bad side-effects. And a small piece of research by the British Heart Foundation found that worry about side-effects is one of the main reasons why people either don’t want to take statins or stop taking them.
What the evidence says
Statins have been used for more than 20 years as a cholesterol-lowering treatment. And there have been lots of good scientific studies to check their effect and safety.
A recent review of many studies found that a similar low number of side-effects were found in both a group taking statins and a group taking a placebo (dummy pill). This highlights two points. One is that statins don’t cause many side-effects in most people. The other is that of the side-effects that do occur, only a small number are genuinely caused by the statin. However, that the research didn’t look at all side-effects and sometimes side-effects only come to light once the medicine is used in real life.
Talking with your doctor
When thinking about side-effects, it’s a good idea to talk through with your doctor any concerns you have. It’s your doctor’s job to make sure they raise this with you. Talking about whether or not the benefits of taking statins outweigh the risks is a key part of being involved with your treatment.
For many people, the benefit of taking statins to prevent another heart attack or stroke outweighs the risk of getting side-effects.
Deciding whether or not to take statins because your doctor has advised that you’re at risk of developing cardiovascular disease (CVD) or having a heart attack or stroke can be difficult. You may feel unsure about taking a medicine that may give you side-effects. However, side-effects are often mild and most people cope with them well.
Statins in older people
In older people (aged 80 and over), statins might not be beneficial. There isn’t enough information from scientific studies to know how well statins work in adults aged over 80. Because of this, it’s not clear if statins should be offered or continued in this age group.
There is also debate about how appropriate statins are for older people, particularly those who are frail. Statins may increase the risk of falls, side-effects and mobility problems. Your doctor will consider all of this carefully and will explain what they recommend is the best treatment for you.
All medicines can cause some side-effects and some people do report problems.
One in 10 people may get side-effects such as:
- blocked nose or sore throat
- nausea (feeling sick)
- pain in your muscles, joints and back
Speak to your pharmacist if problems like these don’t settle. But do see your GP if you have any muscle pain.
One in 100 people may get side-effects such as:
- weight loss or weight gain
- sleep disturbances such as nightmares or insomnia
- blurred vision
- changes in sensation – for example, you might have numbness in your fingers or changes in taste sensation
- a rash
- feeling very tired
- neck pain or tired muscles
Give your new medicine a chance, but if you do feel that the statins are giving you side-effects, speak to your doctor. They may suggest stopping statins for a short while to see if the symptoms settle. Depending on what happens, your doctor may then reduce the dose of your current statin or switch to a different type of statin.
Serious side-effects and what to do
Rarely, statins can cause more serious problems. This may happen to one person in a 1000 people. If any of the reactions below happens to you, stop taking the statin and contact your doctor immediately.
- Allergic reaction that causes your face, tongue and throat to swell and makes it hard to breathe.
- Blistering and swelling to your skin; this may be to your mouth, eyes or genitals and you may also have a fever.
- Pain, weakness and tenderness in your muscles with a high temperature and feeling generally unwell; this might be a sign of muscle damage.
We haven’t included all the possible side-effects here. Please read the patient information leaflet that comes with your medicine for more detail.
For more information about muscle pain, look at our FAQ about statins and muscle pain.
Muscle pain is one of the side-effects that a lot of people worry about getting. Some people taking statins do notice aching in their muscles, but it’s thought that this is rarely caused by the statin itself. It might be because you have a family history of muscle problems, or you have another health condition that could be causing the pain. Alcohol intake is also thought to be a factor. Muscle problems can be more common in older people. Muscle pain may be more likely to happen if you’re taking a higher dose of statins and are taking certain other medicines.
Before taking statins, tell your doctor if you have or have had any unexplained muscle pain. You may need to have a blood test to check your levels of a substance called creatine kinase (CK) in your body. This will help your doctor decide if statins will be suitable for you.
If you haven’t previously had any muscle pain and you start to after taking statins, you should tell your doctor. If it’s going to happen, muscle pain usually happens within the first three months of taking statins. Your doctor will do a blood test to measure your CK level.
Depending on your CK level results, your doctor may suggest you stay on your medicine if the side-effects don’t affect you too much. Or they may suggest you stop the statins and then re-introduce taking them with careful monitoring. If necessary, your doctor may suggest a different statin or a different type of medicine altogether. If your muscle symptoms continue, your doctor may refer you to a specialist at a lipids clinic.
Rhabdomyolysis is a rare but potentially dangerous type of muscle damage where your muscles break down. This is when your CK levels are 10 times higher than usual. The condition can affect your kidneys and liver and may be life threatening. Rhabdomyolysis is very rare. There might be only one or two people who develop it over the course of a year, out of every 100,000 people being treated with statins.
It’s important to know about these side-effects and to weigh them up against the benefits of taking a statin. Talk things through with your doctor.
It’s your choice whether you decide to take statins or not. If you choose not to, your doctor will recommend you have another assessment in the future to find out your risk of cardiovascular disease (CVD). In the meantime they will advise you to continue with lifestyle measures to try and lower your cholesterol and CVD risk.
Lifestyle measures include:
There are several organisations that can offer you help and support.
- Heart UK has a cholesterol helpline. This is a service where you can talk to a health professional about any questions you have. You can ask for yourself or on behalf of a loved one: heartuk.org.uk/cholesterol-helpline
- The British Heart Foundation has a community on their website. Here you can read about other people’s experiences, join an online discussion forum and find out more information about heart disease: www.bhf.org.uk/community
- Cardiovascular disease: risk assessment and reduction, including lipid modification. National Institute for Health and Care Excellence (NICE), last updated July 2016, published July 2014. www.nice.org.uk
- Lipid regulating drugs (including statins). PatientPlus. patient.info/patientplus, last checked 31 July 2014
- Familial hypercholesterolaemia: identification and management. National Institute for Health and Care Excellence (NICE), last updated July 2016, published August 2008. www.nice.org.uk
- The statin conundrum. Heart UK. heartuk.org.uk, accessed 02 August 2016
- Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 2014; 100: ii1–ii67. doi:10.1136/heartjnl-2014-305693
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 02 August 2016
- Cardiology and vascular disease. Oxford handbook of general practice (online). Oxford Medicines Online. oxfordmedicine.com, published April 2014
- Cholesterol. The Association of UK Dietitians. www.bda.uk.com, reviewed October 2014
- What is atherosclerosis? National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov, updated 22 June 2016
- Blaha MJ, Martin SS. How do statins work? Changing paradigms with implications for statins allocation. J Am Coll Cardiol 2013; 62(25):2392–94. doi:10.1016/j.jacc.2013.08.1626
- Lipid modification – CVD prevention. cks.nice.org.uk, last revised October 2015
- Manktelow BN, Potter JF. Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database of Systematic Reviews 2009, Issue 3. doi:10.1002/14651858.CD002091.pub2
- Cholesterol Treatment Trialists' (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: a meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380(9841):581–90. doi:10.1016/S0140-6736(12)60367-5
- Taylor F, Huffman MD, Macedo AF, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 1. doi:10.1002/14651858.CD004816.pub5
- Patient decision aid. Taking a statin to reduce the risk of coronary heart disease and stroke. National Institute for Health and Care Excellence (NICE), November 2014. www.nice.org.uk
- Statins. British Heart Foundation. www.bhf.org.uk, accessed 2 August 2016
- Lipid-modifying drugs. National Institute for Health and Care Excellence (NICE), February 2016. www.nice.org.uk
- Atorvastatin. Medicines.org. www.medicines.org.uk, accessed 25 July 2016
- Fit for frailty. British Geriatrics Society. www.bgs.org.uk, published 2014
- Odden MC, Pletcher MJ, Coxson PG, et al. Cost effectiveness and population impact of statins for primary prevention in adults aged 75 or older in the United States. Ann Intern Med 2015; 162(8):533–41. doi:10.7326/M14-1430
- Perceptions of statins. Research with patients, GPs and cardiologists. British Heart Foundation. www.bhf.org.uk, published July 2016
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- Statins benefits and risks. Medicines and Healthcare products Regulatory Agency. www.gov.uk, published 30 May 2014
- Finegold JA, Manisty CH, Goldacre B, et al. What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. Eur J Prev Cardiol 2014; 21(4):464-74. doi:10.1177/2047487314525531
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Reviewed by Natalie Heaton, Specialist Editor, Bupa Health Content Team, August 2016.
Peer reviewed by Dr Tim Cripps, DM FRCP, Consultant Cardiologist.
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