How To Know If You Need Treatment
Everyone with high cholesterol should start with heart-healthy lifestyle changes like diet, exercise, quitting smoking, and weight loss. But if your cardiac risk is high, you may need treatment with medications, too.
Your doctor can use a formula to calculate a score that shows your risk of a heart attack in the next 10 to even 30 years.
Your cardiac risk is based on a combination of these things:
- Smoking habit or past smoking habit
- Heart disease or family history of early heart disease
You may not need to treat high cholesterol with medications like statins now if you are:
- 19 or younger and donât have FH
- 20-39, with no family history of early heart disease, and your LDL is below 160 mg/dL
- 40-75, and your cardiac risk is low
- 40-75, and your cardiac risk is borderline
- 40-75, and your cardiac risk is intermediate
- 75 or older
- Have advanced liver disease
If your cardiac risk score is borderline or intermediate: Your doctor may talk with you about the risks and benefits of cholesterol-lowering drugs, including possible side effects.
Ask yourself if youâre ready to stick with a healthy diet, weight loss, and exercise. If youâre not, you may want to treat high cholesterol with medication.
If your cardiac risk is intermediate or unclear, but youâre not sure if you want to take medication to treat your high cholesterol, your doctor may suggest one of these heart disease screening tests:
Coronary calcium scan
Why Have I Been Offered Statins
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries and cardiovascular disease .
CVD is a general term that describes a disease of the heart or blood vessels. It’s the most common cause of death in the UK.
The main types of CVD are:
- coronary heart disease when the blood supply to the heart becomes restricted
- angina chest pain caused by reduced blood flow to the heart muscles
- heart attacks when the supply of blood to the heart is suddenly blocked
- stroke when the supply of blood to the brain becomes blocked
A doctor may recommend taking statins if either:
- you have been diagnosed with a form of CVD
- your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk
Find out more about when statins may be recommended.
Trials In Use Of Statins
The lipid-lowering drug cholestyramine was studied in the Coronary Primary Prevention Trial of 1984, and showed a modest reduction in total and LDL-C reduction in coronary events barely reached statistical significance. The Scandinavian Simvastatin Survival Study published in 1994, was the first study that sought to evaluate the effect of statin therapy in the reduction of major coronary events. A total of 4444 men and women with angina or prior myocardial infarction , and serum cholesterol levels of 5.58.0 mmol/L were randomized to simvastatin or placebo for > 5 years. At the end of the study, total cholesterol was reduced by 25%, LDL-C by 35%, and deaths due to CHD by 42% . The benefits of statins in decreasing cardiovascular event rates thus became apparent. Since, then more than 20 large scale trials and several meta-analysis using pooled data have been published, which have demonstrated the effectiveness of statins in reducing cardiovascular events.
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New Drug Data Show Benefits
But the picture is becoming clearer. A slew of recent studies have shown that statins may have significant benefits in older age groups. Your physiology doesn’t suddenly change when you turn 75 years of age, says Steven Nissen, M.D., chair of cardiovascular medicine at the Cleveland Clinic.
In data released in July, researchers followed more than 320,000 veterans age 75 and older for about seven years. There was a 25 percent lower risk of dying from any cause among those who were taking a statin, compared to those who never did and a 20 percent lower risk of dying from a cardiovascular event, such as a heart attack or stroke, among those who started taking a statin after age 75, says the study’s lead author, Ariela Orkaby, M.D., MPH, a physician scientist at the VA Boston Healthcare System and assistant professor of medicine at Brigham and Women’s Hospital.
Whats The Deal With Grapefruit Juice Does It Affect Statins
This is one difference among statin drugs. Unlike atorvastatin and simvastatin , the enzyme that causes a problem with grapefruit juice does not metabolize rosuvastatin . Grapefruit juice inhibits that enzyme, which inhibits the breakdown of your statin, which results in higher statin levels in your body. You cant have grapefruit juice while on atorvastatin or simvastatin, but you can with rosuvastatin.
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Statin Use In Adults Aged 40 To 75 Years
Nineteen RCTs evaluated the effects of statins vs. placebo or no statins in adults aged 40 to 75 years without known CVD. Most of the trials, including the recently published HOPE-3 trial,8 enrolled participants based on an elevated LDL-C level, a diabetes diagnosis, or at least 1 CVD risk factor. Use of low- or moderate-dose statins was associated with a reduced risk of all-cause mortality , cardiovascular mortality , ischemic stroke , heart attack , and a composite cardiovascular outcome .6
Among the study populations, the proportion of CVD events prevented was similar across age, sex, race/ethnicity, lipid level, and other risk factor categories.6 Among trials that stratified participants according to a baseline global cardiovascular risk score, similar relative risk estimates were observed among those classified at a higher vs. lower CVD event risk.10,23
In the absence of other risk factors, adults with an LDL-C level greater than 190 mg/dL may still fall below the risk threshold for statin use for CVD prevention. As noted previously, these persons were generally excluded from the prevention trials evaluating the effects of statin use on health outcomes, because expert opinion strongly favors intervention for these individuals. It is possible that the relative risk reduction in this group is higher than in adults with a lower LDL-C level and that the absolute benefit is greater than would be predicted from a risk calculator.24
Truths About Statins And High Cholesterol
For every drop of scientific evidence that statins are safe and effective, there is a tidal wave of misinformation. Our patients are concerned about statin side effects theyve heard about from family or friends, or read about on the Internet.Statins are the gold-standard for high cholesterol treatment. Theyre a powerful medication, and theyve been proven to save the lives of many men and women living with or having a high risk of heart attack or stroke.But if statins are so effective, why are some people afraid to take them?As with any medication, there are risks associated with taking statins, but the benefits far outweigh the risks for the vast majority of high-risk patients.In an effort to put statin side effects into context and provide honest, scientific answers about statins and their use, weve put together a list of common questions our patients ask us:
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What About Healthy People With Moderately Elevated Cholesterol Levels
What about healthy people who dont fit into the above categories? The guidelines provide clear guidance, but things do get a bit more nuanced. Here, there really needs to be a discussion between the patient and their doctor.
Whether to start a statin or not depends on whether there are other cardiovascular risk factors, such as smoking, high blood pressure, or diabetes, and the actual LDL-C level. A family history of premature atherosclerotic cardiovascular disease would be another factor to consider, as might South Asian ethnicity or premature menopause . Other blood test abnormalities, such as elevated triglycerides or elevated high-sensitivity C-reactive protein levels , might also push towards starting someone on a statin. Another recommendation in the new guidelines is for potential use of coronary artery calcium scans to decide whether or not to initiate statin therapy in select cases where the decision based on clinical risk factors is unclear. Patient preferences and cost are other potential issues to weigh. Online risk calculators may help.
Bottom line: If you are one of the large number of people who fall into this category, talk to your doctor about whether you should be on medications to lower your cholesterol, or whether lifestyle changes are enough.
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Primary Prevention: Is There A Diabetic Individual Who Should Not Get A Statin
Diabetes is a significant cardiovascular risk factor . Furthermore, in individuals with diabetes, a log linear relationship exists between cholesterol levels and CVD regardless of the baseline LDL . Thus, it was assumed, that regardless of the baseline cholesterol level, reducing the LDL will reduce the occurrence of CVD. This led to a number of primary cardiovascular prevention trials using statin therapy as the principal intervention. It has been clearly shown that diabetic individuals with other risk factors should indeed be treated with a statin .
Yet only a few studies have included diabetic individuals without other CVD risk factors . In the Heart Protection Study , 5,963 individuals with diabetes were randomized to 40 mg simvastatin or placebo regardless of their baseline LDL or prior vascular disease status. A significant 22% reduction in the first event rate of major vascular outcomes was noted . Based on the HPS data, an evaluation of the cost-effectiveness of lifetime simvastatin treatment found it to be cost saving even in patients as young as 35 years or with a 5-year risk of major vascular events as low as 5% . These criteria include almost all of the diabetic individuals, including individuals with type 1 diabetes over the age of 30 years and individuals with type 2 diabetes over the age of 32 years for men and 38 years for women .
Primary prevention trials and meta-analysis of statin use in diabetic individuals with no other CVD risk factors
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Patient Population Under Consideration
These recommendations apply to adults 40 years and older without a history of CVD who do not have current signs and symptoms of CVD . Some individuals in this group may have undetected, asymptomatic atherosclerotic changes for the purposes of this recommendation statement, the USPSTF considers these persons to be candidates for primary prevention interventions. These recommendations do not apply to adults with a low-density lipoprotein cholesterol level greater than 190 mg/dL or known familial hypercholesterolemia these persons are considered to have very high cholesterol levels and may require statin use.
Should You Take Statins The Latest Cholesterol Debate Explained
Millions of people around the world take statins to reduce their risk of heart attack and stroke. But new research suggests they may be wasting their time: an international team of scientists has found no link between high levels of low-density lipoprotein cholesterol and heart disease in a study of people aged 60 and over.
A team of academics and cardiologists from Scandinavia, the United States, Italy, Japan and Great Britain analysed 19 studies involving a total of 68,094 elderly people. They found that in 92% of cases, older people who had high levels of this LDL cholesterol lived as long or longer, and were in fact less likely to die prematurely from other diseases, including cancer.
For years doctors have been prescribing statins to prevent cardiovascular disease and atherosclerosis, a hardening and narrowing of the arteries, because they were thought to be linked to high levels of cholesterol.
Now the authors are calling for a rethink of guidelines for statin prescriptions. They wrote: Our review calls for a re-evaluation of the guidelines for cardiovascular prevention, in particular because the benefits from statin treatment have been exaggerated.
But their findings, published in the BMJ Open Journal, have sparked a backlash from other academics, who say there is a wealth of research showing that cholesterol is indeed linked to cardiovascular disease.
What do the experts say?
Have you read?
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What About That Scary Muscle Problem
It is scary, but it is also very rare. As rare as it is, rhabdomyolysis is what your doctor and pharmacist will warn you about. If your muscles start to ache or feel very weak , stop your medication and talk to your doctor. This is not a subtle ache this is an impressive aching and weakness and you will know if it happens.
What Are The Side Effects Of Statins
Statins may cause mild side effects, including:
- Type 2 diabetes or high blood sugar.
Adults and teens can take statins. Most people dont have side effects from statins, but you shouldnt take them if youre pregnant, nursing or have certain types of liver disease. Let your provider know if you have diabetes. If youre already at risk for diabetes, statins can add to your risk of getting it.
Some people have an interaction with another medicine while taking statins. Whenever your provider considers prescribing medication for you, its important to tell them what else youre taking. That includes other prescription drugs, medicines you buy without a prescription, vitamins, herbs, supplements and recreational drugs.
If one type of statin gives you side effects, ask your provider if they can switch you to a different one. You may also want to ask your provider if you need to avoid grapefruit or pomegranate or their juices or if its ok to have a small amount. These foods can make it hard for your body to break some statins down, allowing too much of the drug to accumulate in your body and giving you more side effects.
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What Happens When I Take A Statin
You should have a blood test before starting treatment. This checks the level of cholesterol. It also checks if your liver is working properly. After starting treatment you should have a blood test within 1-3 months and again at 12 months. The blood test is to check that the liver has not been affected by the medication. The blood may also be checked to measure the cholesterol level to see how well the statin is working.
When To Start Taking A Cholesterol Pill The Decision Is
It recommends statin treatment for people with cardiovascular diseases, Statins are usually used to lower blood cholesterol levels and reduce risk for illnesses related to atherosclerosis, | Download > People with familial hypercholesterolemia, Low-density lipoprotein cholesterol, or 2.6 mmol/L.Should You Be on A Statin?Whether you need to be on a statin depends on your cholesterol levels and other risk factors for cardiovascular disease, One promising benefit seems to be their anti-inflammatory properties, people with familial hypercholesterolemia may have a heart attack in their 20s or 30s.Cholesterol MedicationsLast updated: Nov 10, or 5.2 millimoles per liter , her physician wanted to immediately start her on a cholesterol-lowering statin.Cholesterol-lowering statins have transformed the treatment of heart disease, More than one in four Americans over 40 are taking statins
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Types Of High Cholesterol
There are different types of high cholesterol, based on whatâs causing it:
Primary high cholesterol is also called familial hypercholesterolemia . Itâs when high cholesterol runs in your family. You may have very high levels of LDL cholesterol, which puts you at high risk of heart disease, even at a younger age.
How itâs treated: A low-fat diet, regular exercise, and staying at a healthy weight are part of a good plan to reduce high cholesterol. People with genetic high cholesterol likely will also need to treat it with medications, usually a statin. Other medications could include nicotinic acid ” rel=”nofollow”> niacin) to lower your LDL and raise your HDL, bile acid-binding drugs, fibrates, or either ezetimibe or inclisiran in combination with a statin.
If these treatments donât lower your LDL, PCSK9 inhibitors are a newer treatment option for FH. They block a protein to help lower LDL in your blood.
Secondary high cholesterol is linked to health conditions like diabetes, heavy drinking, chronic kidney disease, hypothyroidism, and a high-fat diet or lack of exercise. Certain drugs for other medical conditions, like steroids, can cause high cholesterol, too.
High triglycerides may be caused by an unhealthy diet, obesity, diabetes, heavy drinking, kidney disease, or hypothyroidism. For some people, high triglycerides can be genetic.
American College Of Cardiology/american Heart Association Guidelines On Management Of Lipids 2013
The ACC/AHA brought out the updated guidelines, in November 2013. The guidelines have emphasized the adoption of a healthy lifestyle as the foundation of cardiovascular health. The guidelines have identified four risk groups where lipid lowering measures have been found to be most effective. . Statins due to the overwhelming evidence have been recommended for treatment of elevated cholesterol. It has done away with titrating statin dose to achieve a desired LDL-C level. The dosing of statin has been fixed as high intensity and moderate intensity . For primary prevention in patients considered at low risk the guidelines recommend a discussion between the clinician and patient before initiating statin therapy. The guidelines recommend the use of Pooled Cohort Equation for assessing the 10 years risk of ASCVD. The Pooled Cohort Equations have been derived from cohorts of African Americans and White Americans who were part of five large NHLBI-sponsored observational studies on assessing cardiovascular health. Monitoring lipid profile is also not recommended as routine except to ensure adherence to therapy.
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