Statins: Common questions answered

Professor Richard Hobbs

Statins are prescribed to people with cardiovascular disease and to those at high risk. Some people ask whether statins are safe and are worried about side effects. 

June Davison puts some of your questions to Professor Richard Hobbs, head of Primary Care (Health Sciences) at the University of Oxford and a part-time GP.

Statins are drugs that lower your body’s cholesterol level. They work by reducing the production of cholesterol in the liver and therefore reduce your risk of heart disease. Cholesterol is essential for your body to work, although too much ‘bad cholesterol’ (called low-density lipoprotein or LDL) can lead to fatty deposits building up in your arteries. These fatty deposits can increase your risk of developing conditions such as coronary heart disease, heart attack and stroke.

People who have had a heart attack or stroke will be advised to take a statin to help reduce the risk of them having another event. You’ll also be advised to take a statin if you’re considered to be at significant risk of developing cardiovascular disease, or of having a heart attack or stroke. Even if your cholesterol level isn’t high, you may be prescribed statins to help protect you.

About one in 500 people in the UK have familial hypercholesterolaemia (FH), an inherited condition that causes high levels of cholesterol and which can also be treated with statins.

Are statins safe? They seem to get a lot of negative press

These are very powerful drugs and in the early days of statins, understandably, some people were concerned about potential undiscovered risks associated with them. They’re now one of the most investigated drugs, and we have lots of reliable data – some of which originated from work that’s been funded by the BHF – that show they are very safe and effective to take.

How will taking a statin help me?

It can significantly delay the onset of atherosclerosis (narrowing of the arteries) and reduce the risk of having a serious event such as a heart attack or stroke. Statins also slow down the progression of disease so they can help delay symptoms such as angina (chest discomfort or breathlessness). They won’t reverse the symptoms but they can prevent them from getting worse.

"Most people experience no side effects from statins"

What are the differences between statins?

The main differences are in how much they lower cholesterol. They can be split into two groups – low-intensity statins (for example, pravastatin and simvastatin) and high-intensity statins (such as atorvastatin and rosuvastatin). For most people, a lower-intensity statin will be enough to reduce their cholesterol sufficiently, but if it’s not, your doctor may want to increase the dose or switch to a higher-intensity one.

What side effects are there?

Muscular aches and pains are the most common. It’s natural to associate symptoms with a new tablet but we all get muscle aches from time to time, so it’s difficult to know if they are due to medication or just to do with everyday life. Most people experience no side effects from statins. For some, though, they are an issue. If this is the case, ask your doctor about trying a different statin.

StatinsAn exceptionally rare, but serious, side effect is severe muscle damage, producing pain and weakness in the muscles. It can be reversed if treatment is stopped and most people who develop it make a rapid recovery.

Statins act on the liver so, for a few people, they can affect its function but, again, this is rare. Any side effects need to be weighed against the positives in that statins are generally safe to take and dramatically reduce the risk of heart attacks and strokes, which could be fatal.

What can I do if I experience them?

Talk to your GP. They may reduce your dose or change your statin. If this is the case, they’ll check your cholesterol to make sure that it’s still under control. It’s worth bearing in mind that symptoms with any tablets may improve over time or even disappear.

Can I take a statin if I’m 80?

A criticism of statins is that the earlier trials didn’t include many women and elderly people, so there was a suggestion that they didn’t work in these groups. However, there have been many studies since, which show them to be hugely beneficial in reducing heart attacks and strokes in older age groups and women.

How long do I need take a statin for?

Probably for the rest of your life, because they only work for as long as you continue taking them.

How do I know if my statin is working?

You’ll need a blood test to check that your blood cholesterol level has come down. After starting a statin, it takes about six weeks for cholesterol levels to stabilise, so most doctors would re-check your cholesterol after about eight weeks. You should have a check-up at least once a year or more often if your doctor thinks it is necessary.

I think my statins are giving me nightmares. Can I take them in the morning instead?

"You should have a check-up at least once a year or more often if your doctor thinks it is necessary"

There is no reliable data about whether statins cause nightmares. There are other medicines that can trigger sleep disturbances, which people might also be taking, so it’s difficult to pinpoint it to statins.

Sometimes, if you think a tablet might cause a nightmare, it can increase the risk of having one. For some types of statin, it’s better to take them at night, because that’s when they have a bigger effect on reducing cholesterol. However, the most important thing is that you take them regularly, rather than not at all.

Are there any food or drinks I should avoid?

If you take simvastatin, you shouldn’t drink grapefruit juice as it increases the concentration of the drug in the blood stream, increasing the risk of side effects. If you take another type of statin, limit your intake of grapefruit juice to very small quantities or you may want to avoid it altogether.

I’m on 80mg of atorvastatin but my cholesterol still isn’t low enough. What else can I do?

Eat a healthy diet and avoid foods high in saturated fats. Plant sterols and stanols – which are added to certain drinks and foods – can help to reduce your cholesterol by up to 10 per cent.

Losing some weight, if you’re overweight, can also help. If your cholesterol is not coming down enough, your doctor may prescribe the drug ezetimibe for you as well as your statin to further lower your cholesterol. This helps to prevent your intestine from absorbing cholesterol. As well as taking a statin, it’s important to keep active, eat well and if you smoke, stop.

Statins: a patient’s view

Trevor ClarkeTrevor Clarke, 80, started taking statins in 1995 following his coronary bypass surgery.

“I started on simvastatin, 40mg,” says Trevor. “It was increased to 80mg, because my cholesterol wasn’t coming down enough. Three years ago, I changed from simvastatin to atorvastatin.

My cholesterol is much better, but it’s still not quite low enough. I’m due to go back for a check-up in a few weeks’ time. High cholesterol runs in my family and there is a history of heart disease.

I’ve got friends who say that they’ve had muscle aches but I’ve had no problems with taking statins. I avoid foods that might have an adverse affect on my cholesterol. I also get out and about a lot.”

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