When we updated our guidance on the use of statins in July this year, we recommended that the drugs should be offered to a wider group of people than in the past.
Statins can reduce the risk of cardiovascular disease in people who don’t have it now, but might develop it in the future. Healthcare professionals can estimate how likely it is that you will develop cardiovascular disease using the QRISK2 program. The most common forms are coronary heart disease (CHD – angina or a heart attack) and stroke (including transient ischaemic attack or TIA, sometimes called a ‘mini stroke’).
Previously, we had said that statins should be offered to people who have a 20% or greater risk of developing cardiovascular disease over the next 10 years. But now we recommend that healthcare professionals should offer a statin – usually atorvastatin 20 mg – to people who have a 10% or greater risk of developing it over the next 10 years, if lifestyle changes haven’t reduced their risk or that approach isn’t appropriate (I’ll explain what those numbers mean later in this blog).
But deciding whether or not to take a statin is a personal choice. Taking a statin will reduce your risk of cardiovascular disease, but deciding to take or not take a statin also has other consequences that different people feel differently about. We want each person offered a statin to come to a decision that’s right for them, so if you’re one of those people we’ve developed a patient decision aid to give you information about the pros and cons of taking a statin. The decision aid is designed for you to work through with the healthcare professional who is helping you make this decision, to help you both make the best choice for you.
Reducing your risk
The first step to reduce your risk of cardiovascular disease is still to make a series of lifestyle changes such as:
- Stopping smoking
- Eating a healthy diet
- Getting enough exercise
- Becoming a healthy weight
- Reducing your drinking
We recommend that most people try doing these things before thinking about taking a statin. Your healthcare professionals can help you with these, including help to stop smoking. After you have tried to change your lifestyle, you should be offered another risk assessment to see if your risk of cardiovascular disease has decreased. Your healthcare professional will advise you on when that should be done. If your risk hasn’t decreased enough, you can think about taking a statin to help reduce your cholesterol, to reduce your risk of developing CHD or having a stroke.
Are statins right for me?
The choice is between continuing to make the changes to your lifestyle plus taking a statin, and just continuing with the changes to your lifestyle without also taking a statin – and that choice is up to you.
Understanding the likely benefits from statin treatment on your risk of cardiovascular disease means using numbers, but we know that lots of people can find these difficult to make sense of. That’s why we’ve included some graphics in the patient decision aid that might help.
For example, if you have been told your 10-year risk of cardiovascular disease is 10% then, in a group of 100 people like you, over the next 10 years on average 10 of them will develop CHD or have a stroke at some point in that time (the red faces in the graphic below); and 90 of them won’t (the green faces). But no one can say what will happen to an individual person, or when in the 10 year period they will actually develop CHD or have a stroke if indeed they do.
The graphic below shows what would happen if all 100 people take a statin at the dose we recommend for 10 years. Over that time, on average 90 people will not develop CHD or have a stroke (but they wouldn’t have done anyway) and 6 people will still develop CHD or have a stroke, even though they take a statin. But about 4 people will be saved from developing CHD or having a stroke through taking a statin – the yellow faces. However, it’s impossible to say what will happen to any individual person – whether you’ll be one of the people who benefit from taking a statin, or one of those for whom the statin doesn’t actually make a difference to what would have happened anyway.
Take a look at the patient decision aid to see how the benefits shift for people depending on their cardiovascular risk, ranging from 10% to 40% over 10 years.
What about side effects?
Like all medicines, statins can cause side effects in some people. One type often talked about is muscle problems.
Many people who take statins experience muscle pain from time to time but in clinical trials about the same proportion of people overall had muscle pain at some point, whether they took dummy tablets or statins. The UK independent safety regulator for medicines estimates that in every 1000 people who take statins (imagine 10 blocks of faces like the graphics in this blog) over a year on average 2 of them will experience mild muscle pain. Muscle pain is most likely in the first 3 months of treatment. Some people are more likely to develop muscle problems as a result of taking a statin, so before you start treatment your healthcare professional will ask you about factors that make it more likely that you might get these problems.
Other side effects have sometimes been reported with statins and the patient decision aid explains about the risks of developing these, and also discusses other pros and cons of treatment with a statin.
Making your mind up
There is a lot of information to think about before you decide whether to take a statin or not, but you don’t have to make a decision immediately. The sooner you start treatment, the more benefit you might get. However, for most people a few weeks will not make much difference. Treatment with a statin is usually long term, so it is important that you are happy with your choice. Once you have made a choice, you can change your mind later if you wish or if your situation changes. Your risk of developing CHD or having a stroke will also change over time – in particular, your risk will increase as you get older – so you should have your risk assessed again in the future if you decide not to take a statin now. Your healthcare professional will advise you on when that should be done.