Statins: what options do I have to reduce my risk of coronary heart disease or stroke?

It is a disease of the heart and arteries.  The arteries are the tubes that allow blood to flow around the body.  These tubes become blocked.  This slows down blood flow or makes it stop.

Find out more at: 

https://www.easyhealth.org.uk/pages/23-coronary-heart-disease

https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/coronary-heart-disease

Some strokes are caused when normal blood and oxygen supply to an area of the brain is cut off.  This can cause damage to areas of the brain. 

Find out more at: 

https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/stroke

What is a Statin?

Statins help reduce the amount of bad cholesterol your body makes. 

Bad cholesterol can harden and narrow the tubes that allow blood flow.  This can increase your risk of coronary heart disease or stroke. 

Find out more at: 

https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/statins

How likely is a statin to help me?

Your health professional can estimate how likely it is that you will develop coronary heart disease or a stroke over the next 10 years. This is sometimes described as level of risk. 

You can then discuss the following tools with your health professional to find out how likely a statin is to help you based on your level of risk.    

Your health professional is also likely to recommend lifestyle changes as outlined in this tool.

Taking a statin to reduce risk of stroke, heart attack and death.

 Research studies have been looked at how likely statins can help reduce the combined risk of stroke, heart attack and death . 

Imagine a group of 400-420 people who have all had a stroke.

If these people were to all take a statin at the recommended dose for 1 year, research suggests that on average one of them would be saved from having a stroke during that year.  In other words, one of those 400-420 people would have had a stroke if they had not taken a statin. This statistic is illustrated in the image below:

Also, another 4 or 5 people from the group of 400 to 420 people would be saved from having a heart attack, or from dying. This statistic is illustrated in the image below:

So, out of 400-420 people who have had a stroke and take statins for a year, a total of 5 or 6 people would avoid having a personal emergency.

It is not possible to tell what will happen to you as an individual. It is not possible to predict which of the people would avoid coming to harm by taking a statin. Some of the 400-420 people will have noticed side effects caused by their statin, and might not have seen any benefit. Some people will still go on to have a stroke or heart attack even though they take a statin.

(Note that the statins studied in this research were Simvastatin 40 mg daily, Atorvastatin 80 mg daily, Pravastatin 40 mg daily.)

Find out more about this research at:

The Cochrane Collaboration. Interventions in the management of serum lipids for preventing stroke recurrence. The Cochrane Library 2009, Issue 3 

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002091.pub2/pdf

What are the possible risks of taking a statin?

You can discuss with your health professional  the possible side effects and other risks a statin might have.

Side-effects are unwanted affects that can happen to your body when taking a medicine. 

Not everyone will get side-effects.

Here are some of the common side-effects - which affect up to 1 in 10 people:

• Nosebleeds
• Sore throat
• Blocked or runny nose
• Feeling sick
• Headache
• Diarrhoea
• Constipation
• Indigestion
• Wind
• Muscle and joint pain

There are other side-effects that are less common or rare. 

Find out more at: 

https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/statins#side-effects

Sometimes statins can interact with other medicines.  Discuss with your health

professional whether there is a risk of a statin interacting with any other

medicines you are taking.

Medicines that can interact with some types of statin include:

• Some antibiotics and antifungals.
• Some HIV medications
• Warfarin – a medicine commonly use to prevent blood clots.
• Ciclosporin – a medicine  that suppresses the immune system. This is used to treat a wide range of conditions, such as psoriasis and rheumatoid arthritis.
• Danazol – a medicine used to treat conditions such as endometriosis.
• Verapamil and Diltiazem – medicine used to treat various conditions affecting the heart and blood vessels.
• Amiodarone – medicines used sometimes to treat irregular heartbeats.
• Fibrates – medicines like statins, used to help to reduce cholesterol levels in the blood.

Find out more at: 

https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/statins#cautions-and-interactions

What other issues might you consider about statins?

You can discuss any other issues with your health professional.

Find out more at: 

https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/statins/

Eating a Healthy Diet

• Try to eat less fatty foods. Especially food that has lots of fat such as takeaways, or processed food.
• Try to particularly avoid foods with lots of saturated fat. This is foods such as hard cheese, cakes, biscuits, pies etc. You can look on the food label for saturated fat.   
• Try to choose foods containing mono-saturated fats. These are foods with olive oil and rapeseed oil.
• Try to choose wholegrain types of starchy food. This can be foods such as wholegrain pasta and rice.
• Try to have less sugar or foods with refined (processed) sugar.
• Try to eat 5 portions of fruit and vegetables per day.
• Try to eat 2 portions of fish per week, including oily fish such as Salmon.
• Try to eat 4 to 5 portions of unsalted nuts, seeds and legumes per week. Legumes are foods such as lentils, beans, chickpeas.

Find out more at: 

NHS Inform https://www.nhsinform.scot/healthy-living/food-and-nutrition/eating-well/eatwell-guide-how-to-eat-a-healthy-balanced-diet 

NICEhttp://www.nice.org.uk/guidance/cg181/ifp/chapter/Making-changes-to-your-lifestyle

Getting enough exercise

To improve or maintain your health, you  should try to be active daily.

The recommended exercise levels for people in good health are:

• A total of at least two and a half hours of moderate aerobic activity such as cycling or fast walking every week, and
• strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).  

Speak to you health professional for  more personal advice about how to take more exercise in a way that works for you.

Find out more at: 

https://www.nhsinform.scot/healthy-living/keeping-active/getting-started/types-of-exercise

Maintaining a Healthy Weight

• If you are over weight, losing a little weight can have lots of benefits.
• Losing weight safely and at a realistic pace is the best way to reach your healthy weight and to maintain that weight in the long term.

  For example:

• Cut your calorie intake by between 300 to 500 calories per day.
• Substitute high-calorie food for tasty alternatives. For example, crunchy vegetables instead of crisps.
• Reduce your portion sizes

Find out more at:

NHS inform http://www.nhsinform.scot/healthy-living/food-and-nutrition/healthy-eating-and-weight-loss/how-to-lose-weight-safely

Drinking Less Alcohol

It is recommended that men should not drink more than 3 – 4 units daily and women should no drink more than 2 – 3 units daily. NHS inform (2017 https://www.nhsinform.scot/healthy-living/alcohol/tips-on-cutting-down-alcohol/) suggest ways to reduce how much you are drinking:

• Set a limit on how you are going to drink
• Set a budget
• Let you friends and family know you are trying to drink less so they can support you
• Have a smaller drink (e.g. small glass of wine instead of large)
• Cut back a little each day
• Chose a lower strength drink
• Try to alternate between alcoholic drinks and drinks or water or soft drinks.

Find out more at: 

https://www.nhsinform.scot/healthy-living/alcohol/tips-on-cutting-down-alcohol/

Stopping Smoking

Stopping smoking increases your chances of living a longer and healthier life.

Not only will you to start to save money but you'll experience a reduced risk of:

• heart disease, stroke, diseases affecting the lungs and blood vessels, and a whole range of cancers
• Your life expectancy will be greater, and you'll notice an improvement in the symptoms of smoking related diseases such as Chronic Obstructive Pulmonary Disease (COPD).
• Stopping smoking can help you live life to the full. You'll feel fitter and more able to take part in physical activity. This in turn can benefit your mental health and wellbeing.
• If you would like to stop smoking, you can:
  • Contact Quit your Way Scotland (https://www.nhsinform.scot/care-support-and-rights/nhs-services/helplines/quit-your-way-scotland), the national advice and support service for anyone trying to stop smoking in Scotland.
  • Speak to a health professional at your GP practice or local pharmacy

Find out more at: 

https://www.nhsinform.scot/healthy-living/stopping-smoking

Your health professional will be able to discuss with you the possible outcomes if you choose not to take medicine or any of the other options available.

In preparation for discussion with your health professional, you may want write down your thoughts about the options available to you, and how they affect what matters most in your life. 

You may also want to  note down any questions, any further information or any further actions you need to take.