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Mid-Week MOT - Statins: The great debate..


The purpose of the article this week is not to sway you for or against the use of statins, but to present the facts and figures so that you can make an informed decision should you be advised to take the drugs by your GP.

Statins are in the press fairly frequently and there is much debate surrounding their benefits vs drawbacks, with one camp advocating their use to lower cholesterol and another camp saying the side effects are too damaging to warrant their use. Here are the facts -

Cholesterol

Cholesterol is a lipid (fatty) molecule that is made in the liver and is present in foods containing animal fats (including kidney, eggs and prawns). It is an important structural component of animal cell membranes and is a precursor for the production of steroid hormones, bile acids and vitamin D.

In short, you need cholesterol....you just don't need excessive amounts.

There are two types of cholesterol which are carried in the blood attached to protein molecules - low density lipoprotein (LDL) and high density lipoprotein (HDL).

LDL is the bad boy that causes cardiovascular disease (CVD), narrows the artery lumen and hardens the walls by lining them with fatty plaques.

HDL is actually protective as it shuttles LDL cholesterol from areas where it is in high concentrations to the liver for processing. It is therefore useful to know your numbers when it comes to cholesterol, as high levels of HDL are good, but overall total including LDL should not exceed 5.0 mm/L.

Unfortunately, there are certain drugs which can have the side effect of raising cholesterol and so a discussion with your doctor is warranted if you are on diuretics (water tablets for high blood pressure or oedema), steroid hormones, immunosuppressant drugs, beta blockers and some antidepressants.

There is a minefield of dietary advice available about which fats to have and which to avoid, but not much mention of reducing sugar intake and its link with diabetes as a risk factor for CVS disease. Diabetes makes the body becomes less efficient at processing blood fats like cholesterol and triglycerides.

Bad fats are the trans fat group found in hydrogenated vegetable oils. Saturated fat is not as bad but should be limited to 20-30g a day for adults. Unsaturated fats are the best type with monounsaturated able to maintain HDL levels and polyunsaturated fats actually reducing LDL levels.

A cholesterol count of more than 8 mm/L is classed as very high but this still only plays a small part in your cardiovascular disease risk.

If you are over 40 years of age, you should have your cholesterol levels checked every 5 years (this is now done as part of the new health checks being offered by GP surgeries to this age group).

According to the World Health Organisation (WHO), there are 8 risk factors for coronary heart disease (CHD) -

  • increased alcohol intake

  • smoking

  • high blood pressure

  • raised BMI

  • raised cholesterol

  • high blood sugar (BM)

  • reduced intake of fruit and vegetables

  • reduced levels or no physical activity

  • post menopausal women

Some depressing figures -

According to HeartUK, the cholesterol charity, CHD is the number one killer of under 65's in the UK, with 73,000 people dying each year. Globally, the number is 17.3 million, with £19 Billion pounds spent battling the effects each year.

One person has a heart attack every 7 mins in the UK, with a stroke every 12 mins.

Half of all adults in the UK have a cholesterol count of more than 5 mm/L and more than one quarter are obese (figures as of 2010).

Statins

Statins are drugs that you are likely to be prescribed if you have a 10% risk factor for CHD or you have actually had a heart attack or stroke. This mainly concerns people of pension age but is getting younger and includes people with familial hypercholesterolaemia (inherited high cholesterol).

Statins lower cholesterol and stabilise the fatty deposits in artery walls so that they do not rupture and create emboli (clot like lumps that block heart and brain vessels causing heart attacks and strokes). Once you are on statins you are on them for life but they should be seen as a supplement to health and not a substitute for a clean lifestyle.

Statins go by many names including atorvastatin, simvastatin, fluvastatin, pravastatin and rosuvastatin. Going on them makes sense if your risk of CHD is high due to either a strong family history or your own poor diet and lifestyle choices.

Lifestyle changes that should be adopted before you become ill and even more importantly after, include eating a mediterranean style diet, increasing exercise levels, stopping smoking, reducing alcohol intake and losing weight.

Keep your salt intake low to avoid high blood pressure, eat less sugar to avoid type 2 diabetes, and keep your saturated and trans fat intake to a minimum to keep your cholesterol low.

According to NHS choices, 1:50 people taking the medication for 5 years will avoid serious CVS problems, pretty low odds.

Some of the side effects of statins are:

  • sore throat

  • allergic rhinitis

  • head ache

  • nausea, digestive upset

  • muscle and joint aches

  • nosebleeds

  • increase in blood sugar and associated diabetes risk (ironically)

  • cataracts

So going on them if you are healthy but at increased risk of CHD seems to lean towards the benefits not outweighing the side effects. But the odds go up if you already had a stroke or heart attack. Please speak to your GP or practice nurse if you are worried about your risk for CHD or any other disease. High cholesterol has no symptoms and CVS disease can be a silent killer.

Ultimately, the choice to take statins is entirely the patients, in consultation with their GP and in possession of all the facts, so that an informed decision can be made. In the meantime, make some simple changes to the way you live and protect yourself from preventable diseases.

References and further info:

www.heartuk.org.uk/statins-and-treatments

www.who.int/en/

www.nhs.uk/conditions/cholesterol-lowering-medicines-statins

As always, for osteopathy in High Wycombe and beyond, call Lucy from OsteoFusion on 07833 321604 or visit www.osteofusion.co.uk

Thanks for reading.

#statins #heartdisease #stroke #heartattack #fat #cardiovasculardisease #coronaryheartdisease #cholesterol #lipoprotein #HDL #LDL #hypercholesterolaemia

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