EDP column by Dr Ketan Dhatariya

“I have heard that being on the cholesterol lowering tablets ‘stains’ are good for you. I am 68 years old, why am I not on them?"

It’s true that being on cholesterol lowering tablets can do a lot of good. The technical term for them is 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors – but statins will do. They work by inhibiting the enzymes that are responsible for the manufacture of cholesterol in the liver. It is a common belief that most of the cholesterol in the blood comes from the diet, but in fact, this is less than 20%, the rest is made in the liver.

Cholesterol is an important chemical. It forms part of the membrane that surrounds each cell. It can also be converted into several important hormones such as oestrogen and testosterone. It is important to have some cholesterol in the blood. However, having too much can be bad. There have been several very large studies to show that high cholesterol can be related to an increased risk of heart attacks and stroke. In addition, lowering cholesterol has been shown to reduced these risks. In the past, the only way to reduce cholesterol was by having a healthy, balanced diet and plenty of exercise. However, these would only reduce total cholesterol by about 10 to 20%. If cholesterol was very high to begin with, then even a 20% reduction – whilst being excellent - may not have been enough to bring it down to a ‘safe’ level. That is where the statins come in.

There are some people who are at increased risk of having a heart attack and a stroke (an ‘event’). These include those who have had an event before. In those people, being on statins lowers the risk of having a second event (this is known as secondary prevention). In others, who have not yet had an event, the statins can help prevent it from occurring (primary prevention). Examples of people who may benefit from being on a statin include those with diabetes, or high blood pressure, being overweight, smokers, and those with people in the family who have had strokes and heart attacks.

Being on a statin does not necessarily prevent an individual having an event, but these reductions occur on a ‘population basis’. If several thousand people took the tablets and compared them to an equal number not on the tablets, those on the tablets would have fewer events over a period of years.

The best thing to do is to go and discuss your concerns with your GP. They will know your personal circumstance, and if necessary do a blood test to check your cholesterol levels. Depending on the result, they can then go through the risks and benefits of being on or off the medication with you.

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