3.1 Statins for primary prevention of CVD

Statins are a group of medicines that help to lower your cholesterol and reduce your chances of having a heart attack or a stroke in future.

Coronary heart disease (CHD) is a condition in which the blood vessels in the heart become narrowed or blocked by a build-up of fat. This can result in angina (chest pains) and heart attack. A stroke is when the normal blood supply to part of the brain is cut off, which can damage the area of the brain affected. CHD and stroke are the most common forms of cardiovascular disease. Other forms include a transient ischaemic attack or TIA (often called a ‘mini-stroke’) and peripheral arterial disease (narrowing of the arteries, usually in the legs). Cardiovascular disease is the single most common cause of death in the UK, and is a major cause of illness, disability and poor quality of life. Smoking, high blood pressure and having high levels of fats, such as cholesterol, in your blood increase your risk of CHD or stroke. People with diabetes or chronic kidney disease are also at increased risk of cardiovascular disease.

The graphics on pages 7–21 of the should I take a statin download will show by how much a statin at the recommended dose would reduce your risk of developing CHD or having a stroke, over the next 10 years. You only need to look at the graphics that apply to you. Your healthcare professional will be able to tell you which these are.

You will take 1 tablet once a day. Treatment with a statin is normally long term although you and your healthcare professional can decide to stop it if it is not suiting you.

Many people who take statins experience muscle pain from time to time but in clinical trials about the same proportion of people overall had muscle pain at some point, whether they took dummy tablets or statins. The UK independent safety regulator for medicines estimates that in every 1000 people who take statins, over a year on average 2 of them will experience mild muscle pain. Muscle pain is most likely in the first 3 months of treatment. Rarely, some people taking statins have developed abnormal muscle breakdown, which can lead to kidney problems and be life-threatening. The UK independent safety regulator for medicines estimates that for every 100,000 people who take statins, over a year about 1 or 2 of them on average will experience this type of muscle damage. Some people are more likely to develop muscle problems as a result of taking a statin, so before you start treatment your healthcare professional will ask you about factors that make it more likely that you might get these problems.

The following side effects can affect up to 1 in 10 people who take atorvastatin (the statin usually recommended):

• inflammation of the nasal passages, pain in the throat, nose bleed
  allergic reactions headache nausea, constipation, wind, indigestion, diarrhoea.

Other side effects have been reported with statins, but are less common. For more information see the manufacturer’s information leaflet, such as the one Pfizer has produced for atorvastatin.

Some people who take statins develop diabetes, but some people of a similar age and lifestyle who don’t take statins also develop diabetes. When atorvastatin 80 mg daily (the highest dose) was compared with a dummy tablet in a clinical trial, over an average of 5 years about 9 people in every 100 who took atorvastatin developed diabetes (and 91 in 100 did not), and about 6 people in every 100 who took dummy tablets developed diabetes (and 94 in 100 did not). These numbers are shown as graphics on pages 22– 23. There is no good evidence to say what the risk of diabetes would be over a longer time period and it is possible that it would be less with lower doses of atorvastatin. Some people are at greater risk of developing diabetes whether or not they take a statin. This includes people whose blood sugar is higher than normal, or who are overweight or obese.

Before you start taking a statin, you will need to have a blood test to check how well your kidneys and liver are working. Your liver function will be checked again within 3 months of starting treatment and then a year later. Your cholesterol levels will be measured after 3 months of treatment to see how well the statin is working. You and your healthcare professional might also decide to measure your cholesterol levels once a year.

Whether you take a statin or not, you should try to eat a healthy diet. If you decide to take atorvastatin you should not drink more than 1 or 2 small glasses of grapefruit juice per day because large quantities can change the effects of atorvastatin.

Some medicines may change the effect of statins or their effect may be changed by statins. This could make one or both of the medicines less effective or increase the risk or severity of side effects. If you are starting other medicines, including herbal medicines, or thinking about taking supplements, read the patient information leaflet or talk to a doctor or pharmacist first.