Colesterol and statins

[kingrollo]

Good for you, but I think it's rare for no diet to lower it. I can't lower it enough, but diet still does something, so I do as much as I reasonably can anyway (oat bran, stanols, brazil nuts, olive oil, ...), in the hope of lower doses meaning lower risk of side-effects from the drugs that I have yet to exhaust. Exercise seems to have about the same effect as diet, which is a reason why I cycle.

Depends what is meant by genetic. I have high lipoprotein a - I call this the 3rd type of chlostrel after LDL + HDL.

You probably won't have had this checked. Because there is currently nothing that can be done to lower it (no real treatments yet available) .

However it is a dangerous marker in its own right. It's totally genetic - diet and exercise won't budge it.

Some new treatments for high Lipoprotein a are very close to release - hopefully these will be available in the UK soon.

 

[presta]

I know numerous people who have been offered statins but with no real medical reason.

GPs to be incentivised to prescribe statins.

 

[Tenkaykev]

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GPs to be incentivised to prescribe statins.

Just to point out that the article is ten years old. When I looked into things last year when it was suggested that I start taking statins despite my excellent cholesterol levels I discovered that my 75th birthday had me crossing a threshold where the criteria changes.

 

[mjr]

When I looked into things last year when it was suggested that I start taking statins despite my excellent cholesterol levels I discovered that my 75th birthday had me crossing a threshold where the criteria changes.

That shouldn't be happening now. It used to happen because the QRISK2 heart attack risk calculation was developed for ages 35-74, so it couldn't really be part of the criteria for 75+, but QRISK3 was published in 2017 and covers ages 25-84. If your doctor or care board was last year still using criteria rooted in the limitations of a pre-2017 risk calculator, they need to bring themselves up to date! Can you share the detail of the criteria, such as where you found them?

But even using the latest risk calculations, it basically becomes more and more difficult to avoid a statin suggestion as you age.

I'm worried that this may be a medication that discourages physical activity (due to adverse events being more likely if you exercise) being given to people who should exercise enough, which would be a bit of an own goal.

 

[Tenkaykev]

That shouldn't be happening now. It used to happen because the QRISK2 heart attack risk calculation was developed for ages 35-74, so it couldn't really be part of the criteria for 75+, but QRISK3 was published in 2017 and covers ages 25-84. If your doctor or care board was last year still using criteria rooted in the limitations of a pre-2017 risk calculator, they need to bring themselves up to date! Can you share the detail of the criteria, such as where you found them?

But even using the latest risk calculations, it basically becomes more and more difficult to avoid a statin suggestion as you age.

I'm worried that this may be a medication that discourages physical activity (due to adverse events being more likely if you exercise) being given to people who should exercise enough, which would be a bit of an own goal.

Doesn't time fly. I just checked my NHS records and it shows that it was in fact September 2023. I wasn't 75 until may of the following year. There were several readings such as " total cholesterol HDL ratio 3.1 " total cholesterol measurement 3.8, serum HDL 1.2 " which I took to be ok. I still run and walk regularly and have followed a vegetarian diet for more than 60 years, drink occassionally but not to excess. I can see where there might be some concern as I'm chronically anaemic so the low blood oxygen acts as a limiter on physical activity and sort of self regulates my pace and endurance.

 

[joeegg]

GPs to be incentivised to prescribe statins.

I didn't want to use that statement about incentives but it more or less confirms what my medical professor friend told me.
During the last four years of being prescribed statins no doctor has ever enquired into my lifestyle.
I told one doctor that i felt pressurised to take them and he was pretty sympathetic to my views.
I don't take my statins.When i did my back and shoulders would gradually start to increase in pain.Changing the type of statin actually made it worse.This impinged on my ability to exercise,including cycling,so on balance i stopped them.

 

[Mo1959]

I didn't want to use that statement about incentives but it more or less confirms what my medical professor friend told me.
During the last four years of being prescribed statins no doctor has ever enquired into my lifestyle.
I told one doctor that i felt pressurised to take them and he was pretty sympathetic to my views.
I don't take my statins.When i did my back and shoulders would gradually start to increase in pain.Changing the type of statin actually made it worse.This impinged on my ability to exercise,including cycling,so on balance i stopped them.

I can't see me ever taking them even although my cholesterol was quite high. There's even a thought that, apart from the aches and pains they cause in some people, that they can also cause diabetes and even the risk for dementia.

Stats also show that more people that die of heart attacks actually have normal cholesterol than those who have high.

 

[fossyant]

For those of us who take them, no side effects, no lifestyle changes made the results reduce. Plenty of quack information out there and bad information.

I'm low risk of heart attack given the various results and calculations that have been made. My BP does go high at times but that's life stress. 24 hour monitor showed it was normal when resting.

Just like the rubbish spouted about paracetamol. That said, take too much and you'll die a nasty death.

Plenty of people on this forum that take them with no side effects and have a lowering of bad cholesterol. They work.

 

[roubaixtuesday]

I can't see me ever taking them even although my cholesterol was quite high. There's even a thought that, apart from the aches and pains they cause in some people, that they can also cause diabetes and even the risk for dementia.

Stats also show that more people that die of heart attacks actually have normal cholesterol than those who have high.

This is, I'm afraid, highly misleading, particularly the implication that statin use does not affect cardiac risk.

There are risks with statins, as for all drugs, but the risk/benefit is very clearly positive for indicated populations. This has been extensively studied in clinical trials, it's not just opinion.

You are of course free personally to take whatever medications you wish, but for the population at large, the risks you highlight are lower than the benefits.

See just for instance

https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/lipid-management-pathway-v6.pdf

and

https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf357/8172996

To study the association between statin adherence and the 5-year risk of major cardiovascular events among apparently healthy individuals...
...High statin adherence among apparently healthy users was associated with a significant risk reduction of major cardiovascular adverse events.

 

[Punkawallah]

For those of us who take them, no side effects, no lifestyle changes made the results reduce. Plenty of quack information out there and bad information.

I'm low risk of heart attack given the various results and calculations that have been made. My BP does go high at times but that's life stress. 24 hour monitor showed it was normal when resting.

Just like the rubbish spouted about paracetamol. That said, take too much and you'll die a nasty death.

Plenty of people on this forum that take them with no side effects and have a lowering of bad cholesterol. They work.

In fairness, if you have too much of anything you’ll die a nasty death. And everyone, in a very real sense, has a ‘50/50’ chance of having a heart attack - you’ll either have one, or you won’t.
Just because ‘plenty of people’ take a drug, that’s no reason to see it given to all people, regardless of whether it is considered to ‘work’ or not.

 

[Punkawallah]

This is, I'm afraid, highly misleading, particularly the implication that statin use does not affect cardiac risk.

There are risks with statins, as for all drugs, but the risk/benefit is very clearly positive for indicated populations. This has been extensively studied in clinical trials, it's not just opinion.

You are of course free personally to take whatever medications you wish, but for the population at large, the risks you highlight are lower than the benefits.

See just for instance

https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/lipid-management-pathway-v6.pdf

and

https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf357/8172996

To study the association between statin adherence and the 5-year risk of major cardiovascular events among apparently healthy individuals...
...High statin adherence among apparently healthy users was associated with a significant risk reduction of major cardiovascular adverse events.

‘Associated with’ is not the same as ‘responsible for’. Getting out of bed on a morning is ‘associated with’ longevity, it is not ‘responsible for’ it. I think the expression is ‘correlation is not causation’.

 

[roubaixtuesday]

‘Associated with’ is not the same as ‘responsible for’. Getting out of bed on a morning is ‘associated with’ longevity, it is not ‘responsible for’ it. I think the expression is ‘correlation is not causation’.

Your interpretation of that is mistaken I'm afraid.

For such a study, the statistical analysis has to be submitted in advance, to avoid the issue you highlight.

So the study hypothesised that dosing statins would reduce cardiac events, and then showed that was indeed the case.

It isn't just a random association.

the lay summary:

The present study investigated whether consistently taking statins aids to prevent heart attacks, strokes, or death from heart disease among people who otherwise appear healthy. Although statins are commonly prescribed to lower cholesterol, there has been limited research on their benefits in people without other existing health conditions, and this is the first large-scale study to specifically investigate such a population. More than 150 000 people in Denmark who had no previous heart disease or any major health condition but used statins as a preventive measure were followed. The key findings were the following:

• Individuals who used statins consistently had a significantly lower risk of serious heart disease compared with those who used statins infrequently.
• The benefits from consistent statin use were seen in both men and women and across younger and older age groups.

There are many, many studies showing similar in the medical literature. It's a fact that statins reduce the risk of cardiac events, both for primary (people who've never had an event) and secondary (people who've had at least one event already) prevention.

There is also compelling evidence that statins reduce the overall risk of death: eg https://pubmed.ncbi.nlm.nih.gov/36233511/

Again, this isn't an argument that you personally should take statins, merely that the facts as to the effect on your medical risk are clear.

 

[ColinJ]

Just like the rubbish spouted about paracetamol. That said, take too much and you'll die a nasty death.

Well, that is clearly true since many people have used it to commit suicide!

At a lower level of overuse, believe it or not, it can cause headaches! My brother-in-law took years to discover that most of the 'migraine' attacks he suffered from were actually a reaction to the paracetamol that he was routinely taking in case he had a migraine attack...

 

[ColinJ]

Ah, sorry - I thought you had posted "THEY said", implying that it was wrong!

 

[ebikeerwidnes]

The doctors have been suggesting that I start taking Statins for year and years
I have always asked why and what are the clinical pointers that show I should and they have always said that there are none
but that the stats show that the chances of problems are reduced if I do
but they have never pushed it in any way - just a suggestion

until earlier this year when I had a mini stroke
they now say that the chances of me having another are much reduced if I take them

so now I do - no muscle aches and pains and all that

Anyone know of any studies that suggest an increase in dementure as that does seem to run in my Mum's family and scare me
but I am not willing to do anything about it unless I can see a study that shows in
after all - loosing my mind to dementure and loosing it due to another stroke is a bad choice!!