Should I be taking statins?

Andy Hutchinson, from the NICE Medicines and Prescribing Centre, explains how a new patient decision aid can help you make up your mind whether or not to take a statin to help reduce your risk of having a heart attack or developing angina.

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.

Blog comments

  • I have just started taking. Atorvastatin 4weeks ago and I have a persistent cough and Very little sleep my doctor Tells me my chest is ok but l am debating wether to come off this drug l don't want to be like this all night

  • I am already taking a drug called Colestipol Hydrochloride to bind bile with food. This is essential to me. I cannot do without it. The drug's usual purpose is to lower cholesterol, so for me that is a bonus if I ever needed to lower my cholesterol. I also take 75mg of Aspirin daily.
    It has been suggested that I take Statins. I don't like the sound of taking two drugs that lower cholesterol - at the same time. I also have a multitude of musculoskeletal problems and post operative recovery, with severe muscle pain that I am trying to reduce. I do not like the thought of having my battle with that obstructed by a Statin side effect.
    I think that there ought to be more warnings given about drug interaction consequences.

  • Strange that I know of two people who have been taken off statins by their GPs due to muscle pain. Is the 1:1000 stated above accurate?

  • I have developed a fairly noticeable muscle pain and general lethargy after having taken Atovastatin for several months--age 71 and pretty fit , I have more or less decided to come off the statins

  • I was given Atorvastatin by my doctor and I had to stop taking it as I could hardly walk and the pains in my legs were so severe. He then changed it to Pravastatin and I have been on this for 4 years and no problems at all. My father takes Atorvastatin and he was told he needed heart surgery because his arteries were clogged! How do you explain that? I thought statins were to prevent cardiovascular problems?

  • Hi Joy, it is usually recommended that statins are taken at the same time each day. Why your doctor has said evening would be preferred is better answered by them. Thank you.

  • Hello Chantelle, glad you have found a statin that works for you. Best to speak to your doctor, or your father's doctor about his treatment and pending surgery. Thank you.

  • I was diagnosed as diabetic 2 years ago. My cholesterol has been at about 6-7 for a while. However, my 'good' cholesterol is 1.3 which is very low apparently (ratio 5:5). I was advised to go on a statin at the time of diagnosis but I wanted to do it with diet and exercise. I've reduced my HbA1C to 50 (started at 58) and my blood pressure (123/75) is controlled. I've lost weight. I don't take any tablets. I'm 59 and the guide says I have the heart of a 69 year old. How can they tell about my heart? All the other problems seem to be under control. I come into the 11% category of CVD in the next 10 years. I don't like taking tablets and put it off each day. Surely it means I have an 89% chance of NOT having CVD? The worry of what will happen if I don't take them, and the worry of what will happen if I do (its the worry of what could happen to the rest of my body) is driving me mad! I veering towards taking them because the threat is too worrying, but not sure. Indecisive

  • Hi Anne, thank you for sharing your story with us. We hope your doctor can help you work out the best way forward and whether statins are a good option for you.

  • Hi. I’m a pharmacist and have been taught that statins should be taken at night, as this is when the body makes most cholesterol. Simvastatin doesn’t stay in the body as long as other statins and definitely needs to be taken at night. Other statins, such as atorvastatin, are longer acting and so potentially can be taken earlier in the day if it makes things easier.

  • I’ve been told by go to take Atorvastatin at bedtime!!even though I told her I work nights 3 nights a week so how will that work for me ? I’m extremely scared of taking them and have only took 2and today have bags under my eyes

  • Hi Sue, thanks for sharing your experience. We cannot give individual advice, so please talk to your GP about your concerns. Lisa's comment above might interest you also.

  • I have learnt a lot from this site. I have developed bad muscle pain and a very runny nose. I've never experienced this before although I do suffer arthritis but it's worse on stations. The hay fever symptoms are horrendous. No to stations for me.

  • Thank you for all of your comments, everyone. We will be hosting a Facebook Live about cardiovascular risk sometime in May. Make sure you keep an eye on our Facebook page for more information: https://www.facebook.com/NationalInstituteforHealthandCareExcellence/

  • I was started on atorvastatin before the new guidelines were issued. At the time the starting dose was 10mg and that is still what I take . Now it's 20mg. I feel under treated and more at risk than patients started under the new guidelines.

  • I am really confused about whether to take the statins that my gp has recommended. I am 75 years of age and have been told that I have a high risk of stroke in the next ten years. I am on blood pressure medication which is regularly reviewed to control my blood pressure which seems to go up and down all the time, My total cholesterol is 6.38 and my hdl is 2.46 which I understand is quite good. I am also a bit overweight. I feel fit apart from the usual aches and pains of getting older, Should I now take medication which may cause side effects and restrict my lifestyle and also may cause other problems. Does it make much difference to an older person?

  • Hi John, we say that people should have their circumstance reviewed regularly to see if a change in medication is needed. Please speak to your GP if you are concerned.

  • Hi Gail, sorry to hear this is causing you concern. Please take a look at our patient decision aid and talk it through with your GP as they can help you decide what is best: https://www.nice.org.uk/guidance/cg181/resources/cg181-lipid-modification-update-patient-decision-aid2

  • I had a stroke February, 2017. I was prescribed 40mg Atorvastatin but one day later it was amended to 80mg. I asked the doctor why the doubled dose. He said it was normal. I spoke with a pharmacist and was told it is not normal. I am still on that dosage. Whilst I experienced severe pains (especially shoulder and arm), my main concern is extreme weakness and zero energy. GP can not help. I had 48 hour heart monitor and spirometry test. Everything appears normal. Is it simply stroke causing these problems?

  • Hi My husband who is 63 has been on Atorvastatin for about 5 years. Just over a month ago he had a mini retinal stroke in his left eye. The stroke clinic at the hospital were great, they gave him lots of tests including MRI scans, vascular scans , ECG and blood tests. As a precaution they put him on a 2 weeks course of Aspirin 300mg which was changed to Clopidogrel 75mg thereafter, and for some unknown reason they doubled his Atorvastatin to 40mg. After speaking to his GP about his visit to the Hospital he was informed that all his blood results were fine (both Blood sugar and Cholesterol). For 4 weeks he doubled his Atorvastatin 20mg (Zentiva brand) before starting on the 40mg Atorvastatin (Teva brand) which he obtained from the hospital. After 3 days of taking this brand he contracted severe chronic pain in both wrists and hands and are very swollen. He has stopped taking them until he sees his GP. As I work in a pharmacy I hear a lot of patients comments about different brands that have side effects and do not work as they should. Any comments please

  • I find this all too contradictory I'm 61 don't drink or smoke cholesterol/blood pressure in acceptable ranges I exercise 2 hours per day for years at least 1 hour is 3 x 20 mins rigorous cardiovascular exercise, then 1-hour resistance training. My diet is high in fibre and an appropriate carb v protein mix. My QScore is 13 and statins are suggested. My postcode indicates I live in a deprived area, As Qscore is a statistical tool I propose it is deemed because of my postcode that I have a poor diet and that I drink /smoke, don't exercise and am physically challenged at work. My doctor indicated changing the variables won't make a difference, the only thing to change is my postcode! Really

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