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Should We Be Taking Statins?

Who Should Be Prescribed a Statin?

Statins are one of the most widely-prescribed medications in primary care, but there is a continuing debate about who should be taking them. The change of guidelines in 2014 resulted in more people than ever being eligible for treatment with a statin, with the aim of reducing rates of heart attacks and strokes in the UK.

If a patient is between 40 and 74 years of age, and has no pre-existing medical conditions, they will be automatically invited for a health check by their NHS GP. These checks aim to spot early signs of developing health problems such as heart disease, and involve a series of blood and cholesterol level tests, as well as measuring other values such as a patient’s blood pressure and weight. Once all data has been gathered, an individual’s risk of having a heart attack or stroke in the next 10 years can be calculated using the Q-Risk tool. If a patient’s risk is greater than 10%, their doctor will discuss starting statin treatment.

Why Is This Change in Statin Prescribing Controversial?

Until the guidelines changed in 2014, the threshold for prescribing a statin was Q-Risk percentage of at least 20% – with exceptions for high-risk patients such as type 2 diabetics, or survivors of a heart attack or stroke. The change in guidelines meant that a vast number of people were now eligible for treatment. Experts continue to disagree about the strength of the evidence which caused the guidelines to change, with some arguing that statins do more harm than good in low-risk patients. Although side effects are generally minor, and NICE, the governing body which publishes guidelines in the UK, found the evidence to be robust enough to implement the changes to prescribing across the UK, statins can cause liver and muscle damage.

So, Should We Take Statins If They Are Offered?

If a patient is eligible for statin treatment, they should discuss any concerns with their doctor, not least because the most important treatment for high blood pressure or cholesterol levels is usually a change in lifestyle. Minor changes, such as losing weight, taking more exercise, and stopping smoking, can be enough to considerably reduce the risk. If a statin is still recommended despite this, it’s important to remember that side effects are usually minor and most patients tolerate statin treatment very well. If a statin reduces a patient’s chance of having a heart attack or stroke, then it’s definitely an option most would consider. If a patient has an adverse reaction to the medication, there’s a range of statins from which to choose.

How Do Statins Work?

Statins work by inhibiting an enzyme involved in the production of cholesterol. This reduces the production of cholesterol in the liver and increases its ability to remove cholesterol in the bloodstream. There’s also some evidence that statins reduce the size of existing arterial cholesterol plaques, and lower the risk of developing an irregular heartbeat, or atrial fibrillation. These can reduce a patient’s risk of having a heart attack or stroke.

Which Statin Should I Take?

There’s a range of statins on the market, with some reducing cholesterol significantly more than others. Atorvastatin is the first-line statin in the UK because it’s one of the most effective at reducing cholesterol, but also because it’s associated with a lower risk of muscle damage than other well-known statins, such as simvastatin. In low-risk patients, treatment begins with daily 20mg dose, with higher doses being reserved for higher-risk patients.

Statin treatment has been shown to reduce the incidence of heart attacks and strokes in people that are thought to be at risk. There continues to be debate around how widely statins are prescribed, but the evidence is considered robust enough for doctors in the UK to proceed with prescription. If a patient is over the age of 40, they are often encouraged to visit their GP surgery for an NHS health check – however, an improvement to lifestyle is the single most important change patients can make to improve their overall health and reduce the risk of heart disease or stroke.


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