Statins... or Not?
THIS PAGE IS INTENDED TO BE VIEWED ONLY BY REGISTERED PATIENTS OF OURS WHO HAVE BEEN SENT A LINK TO VIEW IT.
Dear Patient,
If the practice has directed you to this site it is because you are eligible to be prescribed a statin drug by the NHS.
The threshold for offering statins to the public was reduced in early 2023 and guidance continues to flow from NICE which, in essence, recommends that more and more healthy people, many of whom may never go on to develop heart disease should be prescribed drug therapy.
https://www.nice.org.uk/guidance/ng238
The result is that effectively, we are being encouraged to prescribe statins for anyone, independent of their likelihood of developing angina or suffering a heart attack.
You may indeed benefit from taking a statin, (and you may suffer harm – we do not have a crystal ball).
I have read through a lot of the guidance and beyond to try and help you make the decision based upon the likelihood of a benefit, at your level of risk.
Please read the following information to help you make that decision.
“QRISK”
We have software programs that can estimate the risk of someone developing angina, or having a heart attack over the next 10 years. We call it the ‘QRISK’
(As you get older, your risk will naturally increase, but risk also increases if your Mum, Dad, Brother or Sister developed early heart disease, or you are diabetic, overweight, have high blood pressure, or high cholesterol etc)
In contacting you to look at this webpage, we should have told you what your QRISK level is.
AM I AT HIGHER THAN AVERAGE RISK ?
Possibly not. The threshold at which we are now being asked to offer statins has dropped markedly.
Compare your level of risk to the following examples:
The risk of developing angina, or having a heart attack in the next 10 years in the UK for an average weight male, with NORMAL blood pressure, NORMAL cholesterol and NO family history of heart attack at a young age, and NO other conditions eg diabetes, is up to:
At age 55 10%
At age 60 15%
At age 65 20%
At age 70 25%
Advice from Cardiologists and the Government Health advisors was to offer anyone with a risk even as low as 10% on a statin and now they have gone lower.
Many doctors have concerns about ‘medicalising’ large population groups to prevent a disease they may never get, especially when the treatment may cause side effects in more people than it benefits and can statistically only be shown to benefit just a few of those treated.
However, if such medication DOES reduce an individual’s risk of developing heart disease then it may be worthwhile.
IT IS IMPORTANT TO KNOW WHAT THE LIKLIHOOD IS OF YOU GETTING A BENEFIT FROM TAKING A DAILY STATIN TABLET BEFORE YOU EMBARK ON TREATMENT.
FOR PEOPLE WITH A QRISK OF LESS THAN 5%
If you are in this group, taking a statin can still postpone the development of heart disease.
If you are in this group and religiously take a statin for 5 years then you have a
1 in 470 chance of postponing heart disease.
In other words, 469 out of every 470 patients taking the statin would get
no measurable benefit.
FOR PEOPLE WITH A QRISK OF 5 – 7.4%
If you are in this group, taking a statin can postpone the development of heart disease.
If you are in this group and religiously take a statin for 5 years then you have a
1 in 240 chance of postponing heart disease.
In other words, 239 out of every 240 patients taking the statin would get
no measurable benefit.
FOR PEOPLE WITH A QRISK OF 7.5 – 9.9%
If you are in this group, taking a statin can postpone the development of heart disease.
If you are in this group and religiously take a statin for 5 years then you have a
1 in 75 chance of postponing heart disease.
In other words, 74 out of every 75 patients taking the statin would get
no measurable benefit.
FOR PEOPLE WITH A QRISK OF 10 – 19.9%
If you are in this group, taking a statin can postpone the development of heart disease.
If you are in this group and religiously take a statin for 5 years then you have a
1 in 62 chance of postponing heart disease.
In other words, 61 out of every 62 patients taking the statin would
get no measurable benefit.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174924/
( Another analysis of the groups above rated the overall likelihood of the groups above benefitting over 5 years to be just 1 in 217 )
https://www.thennt.com/nnt/statins-persons-low-risk-cardiovascular-disease
So, if you are feeling lucky, then all the effort of taking drug therapy and its associated potential for side effects may work out for you, but the odds are that it will have no benefit to you.
Are you likely to get side effects from the medication?
Statistically, No. Estimates vary and statins are thought to generally be safe medications. They can however clash with other medicines and with certain foods.
Prior to last years NICE update it was thought that approximately 1 in every 21 patients who took statins would get side effects.
The NICE guidance last year suggested that although statins could cause muscle damage, diabetes and dementia, the overall risk was more like 1 in 100.
WHAT IF MY RISK IS OVER 20% ?
Over 20% QRISK you become more likely to get a benefit .
NICE have produced data showing that,
at the higher risk of 25%
**..**then if 100 patients took a specific statin for 10 years, as many as 9 out of the 100 would have a heart attack delayed, or prevented.
(91 out of 100 would see no benefit)
At 30% risk
.. then if 100 patients took a statin for 10 years, as many as 11 out of every 100 would benefit in the same way.
(89 out of 100 would see no benefit)
Whilst it remains unlikely that you will benefit, the odds are better, and higher than this level the number of patients needed to be treated for one to get a benefit continues to drop.
AM I TOO OLD TO BENEFIT FROM TAKING A STATIN?
Age 50-75
Independent of their calculated risk, in patients aged between 50-75 who had no established heart disease, 100 patients would have to take a statin for 2.5 years to delay one of them having a heart attack or developing angina. (The other 99 had no demonstrable benefit).
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773065
Age > 75
Despite the risk of heart disease being naturally higher, the benefit reduces, possibly because of the long duration of statin treatment required to get a measurable benefit.
The Lancet:
“there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of “(heart disease).
SUMMARY
Only a minority of patients without established heart disease will benefit from taking a statin.
The majority of people who go on to have a heart attack will have one irrespective of whether they took a statin or not.
The decision whether to take or not is yours, but also consider that there are other proven ways of reducing your chance of developing heart disease without taking drugs, which in combination would be FAR more effective than just taking a statin.
Research has suggested that even eating an apple a day is more than 90% as effective as taking a statin.
Obvious and effective actions would be :
Reduce your belt size (ie lose weight if you are over a BMI of 25)
Get more exercise
Destress
Stop smoking!
See here:
https://www.amazon.co.uk/Statin-Free-Life-revolutionary-tackling-disease/dp/1529354102
Please consider how you feel about taking such a medication, and if you DO wish us to prescribe them, please leave a message with Reception.
If we don’t hear from you we shall assume that you wish to decline prescription medication and manage your cholesterol naturally.
Dr Davidson