Dr Mark Porter: What you must know about statins

The opinions on such drugs are controversial, but some people say you can never miss if you want to have a healthier life.

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Statins become more and more popular nowadays, so now we can add them to the list of “death and taxes” duo. When you enter middle age you will be offered to take some of these drugs to reduce the level of cholesterol in your body, no matter how healthy your lifestyle is. The doctors are claimed to know the best, so would you accept such a prescription?

Depends on the doctor, I would say. For example, professor Sir Rory Collins has just recently helped a team from Oxford to find out these drugs have more benefits that drawbacks. Yet, cardiologist Dr Aseem Malhotra says it’s better to adapt your diet than take redundant pills.

You can listen to their dispute on the matter, but it won’t make the situation clearer. Two doctors hurling different interpretations of the same data at one another leaves none of us any the wiser. Rest assured that you are not the only one who is confused. Here is what I think my patients need to know before deciding.

First, most of the controversy surrounding the benefits and side-effects of long-term statin therapy centres on primary prevention, that is prescribing them to people who are generally otherwise healthy to prevent future problems. If you have already had a heart attack or stroke (secondary prevention) then the benefit/side-effect balance is tipped very much in your favour.

For the rest of us the most important thing to understand is that unless your cholesterol levels are very high (such as 8 or more), it doesn’t matter too much what your blood test shows. It is all about your cardiovascular risk and cholesterol is just one small part of that.

Statins do lower cholesterol levels, but that is not their only beneficial effect. They also work by “stabilising” fatty deposits in the walls of your arteries, reducing the likelihood of them rupturing and blocking off the blood flow to part of your heart or brain — which is why they are offered to people with seemingly healthy blood fats.

Under current guidance your doctor is likely to suggest a statin if your risk of heart attack or stroke in the next decade exceeds 1 in 10 (10 per cent). And even if you have perfectly normal cholesterol levels and are well, you are likely to cross that threshold as you approach your 60th birthday if you are a man, and by your mid-sixties if you are a woman.

At least 100 people have to take statins for five years to prevent just one of them having a heart attackILLUSTRATION BY JOE MCLAREN

You can work out your level of risk — or at least the best guess based on what studies show happens to groups of people like you — by using the same calculator as your doctor (see below). However, even if the result comes back as higher than 10 per cent, statins should be the last option on your list.

Treat your risk as a wake-up call, particularly if it’s high for your age due to accompanying problems such as family history, smoking or raised blood pressure. Your first reaction should be to look at self-help measures that will protect you, and not just against heart disease and strokes.

Lose weight if you are carrying too much. Start an exercise programme. Stop smoking, and eat healthily by cutting back on excessive carbs, particularly sugars, and following a Mediterranean-style diet. This won’t just reduce your risk of cardiovascular disease but could help to ward off cancers too, as well as improving your sense of wellbeing and helping with the management of common accompanying health problems such as diabetes and high blood pressure. By all means polish the diamond by adding in a statin, but I would urge you to regard it as a supplement to diet and lifestyle, not a substitute.

And don’t expect statins to work miracles. At least 100 people have to take the drugs for five years to prevent just one of them having a heart attack — a surprisingly small benefit that has to be balanced against the risk of side-effects that range from aching muscles to cataracts and diabetes.

Most people on statins are not troubled by side-effects, but equally most of them don’t benefit either. Any clearer?

The heart-attack test

■ We use QRisk2-2016 in my surgery to calculate the odds of heart attack and stroke. You can work out yours at qrisk.org

■ As well as entering your age, postcode (it takes deprivation into account), smoking habits and family history, you will need to know your blood-cholesterol results, blood pressure and your height (cm) and weight (kg).

■ Up until recently the threshold for offering statins for primary prevention was 20 per cent. It is now 10 per cent, and even lower in America at 7.5 per cent.

Q&A

Q I am in my early fifties and have noticed that my sense of smell isn’t as good as it used to be. My wife remembers reading an article that you wrote suggesting this could be a sign of Parkinson’s disease and now I am starting to worry.

A A poor sense of smell can precede the diagnosis of Parkinson’s disease up to 20 years before the onset of classic signs such as stiffness, slowness of movement and tremor. It often starts with difficulty discriminating between odours such as orange, coffee and peppermint.

However, please don’t get too worried. Parkinson’s disease is comparatively rare and there are much more common reasons why people may have a poor sense of smell, ranging from viral infection to allergies such as hayfever.

Another possible early warning sign is constipation. Most people suffer with it at some stage during their life, but if it starts after the age of 40 and is a persistent problem with no obvious explanation then it may be linked to Parkinson’s. Indeed the latest research suggests that middle-aged men and women with constipation are around three times more likely than the rest of us to go on to develop the disease.

Regularly acting out vivid dreams (such as kicking out or screaming) can also suggest subtle changes in the brain that precede Parkinson’s disease.

For more information on early clues, visit parkinson.org
If you have a health problem, email drmarkporter@thetimes.co.uk