Statins and Cholesterol

Noreen Devanney

Primary Care Pharmacist

Surrey Heath CCG

What are Statins ?

• Statins are drugs that lower cholesterol

• They act on the liver to decrease production

• Usually act within 4 weeks

Why take statins ?

• If you have high levels of blood cholesterol you are more likely to have a heart attack than people with lower cholesterol levels.

• Lowering your cholesterol will reduce your risk of cardiovascular disease ie heart attacks, strokes and angina

What is cholesterol ?

• Cholesterol is one of the primary building blocks that your body’s cells need to create structural integrity and fluidity.

• It is a waxy substance naturally produced by your liver

• Levels of cholesterol are increased if you consume a diet that is too high in cholesterol that comes from meat, poultry, and full-fat dairy products.

Good Cholesterol /Bad Cholesterol

• You may have heard the terms “good cholesterol” and “bad cholesterol.” These refer to the two forms in which cholesterol occurs in your bloodstream.

• Low Density Lipoprotein (LDL) cholesterol is the “bad” one, because if you have too much of it, it can lead to atherosclerosis (narrowing of the arteries), and thus heart disease.

• High Density Lipoprotein (HDL) cholesterol is more beneficial, because it actually helps your body to collect excessive amounts of LDL cholesterol and route them back to your liver.

High Cholesterol

Too much cholesterol can build up in your arteries

• Causing atherosclerosis, or hardening of the arteries. • Restricting blood flow through the arteries

• Leading to serious medical problems such as heart attack or stroke.

Identifying Cardiovascular Risk

• Cardiovascular diseases include heart attacks, strokes or angina.

• Your surgery has a plan for identifying patients who are at risk of developing cardiovascular disease

• You may be offered a risk assessment if you are over 40 years.

• This will estimate your risk of developing cardiovascular disease

Reducing Cardiovascular Risk

• losing weight if you are obese or overweight, • taking steps to lower your blood pressure, • stopping smoking • getting your diabetes under control if you have it. • diet, exercise, and lifestyle changes to lower their cholesterol levels. limit

your intake of total fats , especially saturated fats • limit your consumption of sodium (salt) • increase the amount of exercise you get.

These measures often work to bring cholesterol levels down to more acceptable levels. If they do not, your doctor may prescribe medications called statins.

Dietary Cholesterol Reduction

• Eating less fat –fried or processed foods.

• Avoiding saturated fats eg fatty meat ,butter and cheese ,pastry, cakes and puddings

• Choose mono-unsaturated fats such as olive oil and rapeseed oil , nuts and seeds, olives ,avocados

NICE Guidelines

Offer lipid modification therapy primary

• to people who have a 10% or greater 10-year risk of developing CVD.

• to people with established cardiovascular disease (for example past or current history of myocardial infarction, angina, stroke, transient ischaemic attack, or peripheral arterial disease).

What difference will taking a statin make to my risk of Cardiovascular Disease ?

Cardiovascular Risk over 10 years

10%:no statin

If 100 people at this level of risk take no statin, over

10 years on average:

90 people will not develop CHD or have a stroke

(the green faces)

10 people will develop CHD or have a stroke (the

red faces).

Cardiovascular Risk 10% over 10 years :taking atorvastatin

If all 100 people take

atorvastatin for 10 years, over

that time on average:

4 people will be saved from

developing CHD or having a

stroke (the yellow faces)

90 people will not develop CHD

or have a stroke, but would not

have done anyway (the green

faces)

6 people will still develop CHD

or have a stroke (the red faces).

Cardiovascular Risk 40% over 10 years :taking atorvastatin

If all 100 people take atorvastatin for

10 years, over that time on average:

15 people will be saved from

developing CHD or having a stroke (the

yellow faces)

60 people will not develop CHD or

have a stroke, but would not have done

anyway (the green faces)

25 people will still develop CHD or

have a stroke (the red faces).

Why select a statin for someone at below 20% risk ?

Example :

• Woman aged 35 with raised cholesterol and one other risk factor such as smoking or high blood pressure

• May have a low risk over next 10 years

• Risk of heart attack or stroke in her 50s or 60s is high

• By treating at 35 risk of first event can be significantly delayed

• Consequence of not treating is that she may not make it to retirement as more than one in every 5 first heart attacks is fatal

Headlines !!!

Statin Side Effects

• Statins are safe, effective and generally very well tolerated • They have been used for more than 20 years as a cholesterol-lowering

treatment.

• Statins have been widely tested in good quality long term clinical trials involving tens of thousands of patients. The number of side effects in these studies was low with no significant differences between the groups of patients taking the statin and those taking a placebo (dummy pill).

• However all medicines can cause side effects

• Side effects can vary between statins and the amount of the statin taken (dose). Some people appear to more sensitive to statins than others.

Myth 1: You should avoid statins if you have

diabetes

• People with diabetes benefit the most from

statins, which reduce their risk of heart attack, stroke and death.

• While statins may increase blood sugars, this does not offset the overall benefit that statins provide.

• Monitor your sugars, watch your diet and include regular exercise in your routine.

Myth 2: Statins will cause muscle damage and hurt your heart

• Statins have been tested in more than 1 million patients and overwhelmingly, research shows they do not cause heart damage.

• They can cause mild muscle ache for a small number of people (2 in every 1000 treated for a year)

• Doctor will assess risk factors eg drug interactions, blood tests

• Usually within the first 3 months

• Even more rarely, statins can cause severe muscle pain (1 or 2 in every 100,000) —talk to your doctor immediately.

Myth 3: Statins cause cognitive dysfunction or dementia

• Not documented in product SPCs as a side effect ,not identified in trials

• More recent studies have looked at dementia and cognitive changes and found that statins may be beneficial and can prevent dementia – especially with long-term use.

• More evidence needed to confirm this

• Research has found that most people can tolerate statins either by changing the medication type or by staggering their doses.

• Don’t give up on this life-saving medicine: Work with your doctor to find the right drug and the best dose for you.

Myth 3: Being statin-intolerant means you will

never be able to take a statin

Myth 4: Older adults do not benefit from statins

• Older adults can benefit from statins depending on their life expectancy and the likelihood of achieving a true benefit with this therapy.

So, how do we explain the many patients who report side effects ?

• A recent review of statin studies ( over 83,000 subjects ), concluded that only a minority of the symptoms reported in these clinical trials were genuinely due to the statins

• Symptoms occurred just as frequently on the placebo • Many of these symptoms occur relatively commonly in older people who

are most commonly taking statins • it is inevitable to consider that the treatment is responsible even when it

is blameless, and that applies to statins.

• Because of the raised awareness of possible side effects by the media, they can be increasingly reported. Doctors should be alert to looking for other causes.

Common side effects

• The following side effects are the most common but can affect less than 1 in 10 people (but more than 1 in a 100) who take atorvastatin (the statin usually recommended):

-inflammation of the nasal passages, pain in the throat (nasopharyngitis) -allergic reactions -headache • Other side effects have been reported with statins, but

are less common. For more information see the manufacturer’s information leaflet

How long do I have to take a statin?

Once you have been prescribed a statin, it is important to continue to take it every day , this will :

o Keep your cholesterol low

o Reduce your risk of future health problems.

If for any reason you are unable to continue to take your statin you should speak to your GP as soon as possible.