Statins?

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 ian caton 21 Jan 2020

Dr recommends I take statins because I am over 60.

What does ukc think?

My cholesterol is fine, as is blood pressure. Seems I have a 10.1% chance of a heart attack or stroke in the next ten years. The docs  threshold is 10%. The main, if not only, risk factor is my age.

Thanks in advance. 

Post edited at 13:02
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 neilh 21 Jan 2020
In reply to ian caton:

Is that due to family history or what?

Why the 10.1%?

Rigid Raider 21 Jan 2020
In reply to ian caton:

I wouldn't. Everybody reacts differently to drugs and doctors play the game of statistics - if 85% react well to a drug they'll try you on that one but if you react badly they'll try another one, like the garage mechanic who keeps throwing parts at your car at your expense in the hope of fixing it, rather than diagnose the problem. 

A colleague of mine was a fit healthy squash player but had some heart issues. His Dr put him on statins and he says they almost ruined him; he went from being fit and vigorous to being slow, lethargic, tired, fat and unwell. He decided to stop them and they weaned him slowly off the statins, now six months later he feels 100% again and shocked at the effect the statins had on him. 

2
 Timmd 21 Jan 2020
In reply to ian caton:

I'd possibly ask him how accurate the extra 0.1 percent is, and stay active and not take them.

1
 neilh 21 Jan 2020
In reply to Rigid Raider:

Equally the statins could work perfectly fine and may save the OP.So from1 example it is difficult to draw any reasonable conclusion.

Most of the time as I see it it comes as a shock to people to learn that they should consider statins.It does not mean that it is wrong.

 Bacon Butty 21 Jan 2020
In reply to neilh:

Remember, ALL drugs have side effects.
For an increase of 1 in 1000 chance, I wouldn't take them, OP's decision.
I'm 60 in a couple of months time, btw.

edit: there are probably other ways of reducing his risk without resorting to medication.

Post edited at 14:29
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OP ian caton 21 Jan 2020
In reply to neilh:

They don't say how their model works exactly. No family history. They just say my age is the major risk factor. 

My understanding is statins reduce your bad cholesterol. Mine is very good, not perfect. My good cholesterol is very high so the ratio is excellent. Guess things could always be better, no? 

1
 Timmd 21 Jan 2020
In reply to ian caton:

> My understanding is statins reduce your bad cholesterol. Mine is very good, not perfect. My good cholesterol is very high so the ratio is excellent. Guess things could always be better, no? 

I'd be very keen to know about the side effects in your situation. Being type 1 diabetic, I'm liable to be put on them at some point if my cholesterol levels aren't within the right ballparks, something of a motivator to stay active and eat healthily. 

 Trangia 21 Jan 2020
In reply to ian caton:

Get a second opinion from another doctor, ideally a heart specialist?

You might like to consider this, for what it's worth. The BHF are the experts.

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/as...

 Timmd 21 Jan 2020
In reply to Taylor's Landlord:.

> edit: there are probably other ways of reducing his risk without resorting to medication.

That's what I'm thinking, and where I'd be looking first. I happily take Venlafaxine for my depression for what it's worth, but the OP's risk calculation seems to be just based on age rather than lifestyle or health.

Edit: My Dad is in his early 70's and isn't on statins when I think about it, he's always been fine like the OP is with his blood and heart health measures...

Post edited at 15:10
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 neilh 21 Jan 2020
In reply to ian caton:

My big thing was family history but when  explored this in greater detail both the Dr and I decided there were other factors that caused issues there which were not relevant for me.So all OK.

Its a tough decision as the Dr might be perfectly correct in saying this is the best course for you.

Can you not say review it in a years time and see if there is any change in the numbers?

1
Moley 21 Jan 2020
In reply to ian caton:

I think it is your call and agree it is very hard to be subjective as to what is best, most of us are not GPs or have formal medical experience. But quite honestly, I wouldn't put your life in the hands of UKH advice - no offence to anyone.

Been there myself, now aged 67, slightly high blood pressure (most of my life so probably hereditary) and take small dose of amlodipine daily. GP wanted to put me on statins years ago, but as my cholesterol was fine, weight ok, non smoker, fit and exercise plus no hereditary heart disease, he sort of agreed that they were not essential, yet. I've kept my head down since then and not brought the subject up!

I certainly didn't want them just for the sake of it, but if I do have a heart attack at the weekend and it could have been prevented by statins I shall be pig sick at not listening to his advice.

 Timmd 21 Jan 2020
In reply to Moley: My question in the OP's situation would be whether my age really did make a 0.1 percent difference, when other people (like my father in my case) don't get put onto them at the age of 73.  I'm wondering if inherited factors and things actually being out of line are more important than one's age, and whether it's a world wide approach to statins, or just a UK one, too. Now that I've started pondering it, there can be quite strong differences in how different countries approach certain medical issues. A look at what other countries do might help the OP to come to a broader conclusion.

Post edited at 15:57
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 Rob Parsons 21 Jan 2020
In reply to Timmd:

> My question in the OP's situation would be whether my age really did make a 0.1 percent difference

The GP obviously won't be able to answer that. It's all necessarily just averages.

>   I'm wondering if inherited factors and things actually being out of line are more important than one's age

Quite clearly: yes.

Post edited at 16:04
 nikoid 21 Jan 2020
In reply to ian caton:

Ask yourself how many people are taking statins now and whether heart disease rates have been significantly reduced. Statins work by disrupting cholesterol synthesis and cholesterol is vital for hormone production and brain function, amongst other things. So tinkering around with that doesn't sound like a great idea to me. Statins have been linked with muscle problems, memory loss and diabetes. I think it's more likely you'll suffer harm than having your life extended. So statins are not for me.

Post edited at 16:37
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OP ian caton 21 Jan 2020
In reply to Trangia:

Hmmm, very good. That basically says give them a go. 

 petemeads 21 Jan 2020
In reply to ian caton:

Plenty of info on the net, I respect Dr Malcolm Kendrick and Dr Zoè Harcombe - neither has any time for the cholesterol hypothesis or statins. They don't seem to suit old people or women and offer only a few extra days of life on average. The BHF is apparently too close to the pharmaceutical industry to be neutral in their recommendations. Do your own research but I would not go near them.

4
OP ian caton 21 Jan 2020
In reply to Moley:

I posted because there can be a lot of good sense on here.

I have been minded to skip them and thought that would be reinforced by the responses I got. But actually I seem to be leaning the other way. It's not the 0.1% that bothers me it's the other 10. That seems quite high to me.

As has been said the side effects are key. I can see I need to dig into that a bit more and maybe have a chat with another Dr.

Maybe a super low dose is appropriate, which I guess is what would be prescribed. I can always back off. It seems they save 7000 lives a year in the UK. Maybe one is mine. 

Post edited at 16:36
1
 GrahamD 21 Jan 2020
In reply to ian caton:

I'm nearly 60, and recently had a procedure for atrial fibrilation.  I've been on statins to reduce stroke risk for about a year and can't say I'm aware of any side effects.  Seems sensible to stay with them for me.

Why not start with them and see how you get on ?

OP ian caton 21 Jan 2020
In reply to petemeads:

Out of interest why do you respect their opinion particularly and what evidence is there of the BHF being too close to industry?

This is the problem with the modern world. You can find any opinion you want. Sorting the wheat from the chaff is tricky. 

 Rob Parsons 21 Jan 2020
In reply to ian caton:

> This is the problem with the modern world. You can find any opinion you want. Sorting the wheat from the chaff is tricky. 

Nobody on the planet can tell you for sure whether or not taking statins will be beneficial for you: the body is not a machine, and everybody's physiology is different. Your GP will be giving you advice as per the NICE guidelines, but this is just statistical advice. There is no definitively 'correct' answer for you personally - much as that would be nice.

1
 druss 21 Jan 2020
In reply to ian caton:

The efficacy of statins is being questioned by a lot of doctors and research.  Research suggests that patient (pre-heart attack) outcomes are far from effective.  For prior heart attacks statins are beneficial, but not before.  Side effects are more of a sure thing than the risk its meant to mitigate

What is your doc basing 10.1% on?  Only because of your age?  Sounds complete rubbish to me.  Go for CAC scan. 

See https://thefatemperor.com/ for information.

Watch https://www.diabetes.co.uk/in-depth/aseem-malhotra-great-statin-con/

cholesterol information - https://cholesterolcode.com/  There's a ton of information here and you'll end up going as deep as you want.

Obviously try get second opinion and also remember to ask what success rate is associated with medical advice and who funded the supporting study.  If its funded by big pharma then it should doubly questioned!  

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 The Lemming 21 Jan 2020
In reply to ian caton:

> Dr recommends I take statins because I am over 60.

> What does ukc think?

Statins are bad for me. They have a slight side effect of banging head aches, wasting muscle mass of the major climbing muscles and excruciating joint pains.

Not all they are cracked up to be.

2
 nikoid 21 Jan 2020
In reply to ian caton:

> Maybe a super low dose is appropriate, which I guess is what would be prescribed. I can always back off. It seems they save 7000 lives a year in the UK. Maybe one is mine. 

Statins cannot save lives, death can only be delayed. It would be interesting to see some data on the life extending properties of these drugs, I suspect this data hasn't been published as it's pretty unimpressive!

4
OP ian caton 21 Jan 2020
In reply to druss:

Good links. Thank you. 

OP ian caton 21 Jan 2020
In reply to nikoid:

Good point. 

OP ian caton 21 Jan 2020
In reply to The Lemming:

I don't fancy any of that. Thanks for input. 

 petemeads 21 Jan 2020
In reply to ian caton:

Everybody has said what I would have if I didn't have to cook dinner! The two I mentioned earned my respect, plus the people who comment on their blogs who offer their own anectdotal evidence. The internet is great for gathering anecdotes.  The GP's calculator is programmed to ensure that everyone, no matter how healthy, will have a 'statin age' to reduce the risk of heart disease in the next 10 years.

Yes to the use of statins after heart attack, if tolerated, but they probably do not give benefit by reducing cholesterol - and higher cholesterol levels seem to give protection at greater ages.

The CTT group will never release their statin testing data due to commercial considerations - they are not well respected, or trusted, by a good chunk of the informed community.

Same logic applies to the new, super-expensive cholesterol lowering drugs.

 Dan Arkle 21 Jan 2020
In reply to nikoid:

>Statins cannot save lives, death can only be delayed. 

Is this in the same way that seatbelts, helmets, cancer drugs or climbing ropes cannot save lives because we all die eventually??? 

What a ridiculous thing to say.

[I have no strong views on statins] 

1
 The Lemming 21 Jan 2020
In reply to ian caton:

> I don't fancy any of that. Thanks for input. 


Ho, I almost forgot, the memory loss is accurate as well.

No pun intended.

 Chris Shorter 21 Jan 2020
In reply to ian caton:

Would you be the ian caton that I knew at Bangor Normal College?

Chris

 hokkyokusei 21 Jan 2020
In reply to ian caton:

It's worth asking your Dr if your post code is having an effect on your 'risk'. My brother died of a heart attack at the age of 39, and there was some prior family history ( grandfather, uncle) and so I was diagnosed as being 'at risk' (12% chance in the next 5 years) and so I was very careful and went for six monthly check ups as instructed, for the next three years. 

Then I moved house. Suddenly my new practice said my risk was <7% in the next ten years, no check ups necessary. The only difference being my post code. I had moved from the relatively impoverished, inner city BD1 ( with substantial population from South Asia - statistically at great risk of heart disease than Caucasian populations) to the relatively affluent BD16. Changes to my health and lifestyle - none whatsoever, but no longer at substantial risk. In fact I probably never was.

In reply to Timmd:

I am type 1 and have been on statins for more years than I care to remember and have never had high cholesterol problems. You can get information on the side effects on the interweb and they will vary from person to person. My worry was muscle fatigue but have never had a problem with that that cannot be explained by a hard session at the wall, gym or on the hill.

 nikoid 21 Jan 2020
In reply to Dan Arkle:

I think it's fair enough to claim things like seatbelts and helmets save lives in the sense that many extra years of life can result from their use. The same is not true of statins where everything I have read suggests they do not extend lives significantly. It is therefore misleading to talk about lives "being saved" by statins.

1
OP ian caton 21 Jan 2020
In reply to Chris Shorter:

Technically I was at Bangor uni. Left in '77, I think. Used to climb with Keith Robertson and dave Roberts a bit. If that fits then yes, and hi, hope you're good!. 😊 So long ago. 

In reply to ian caton:

Hi Ian- it’s not a clear cut decision. Here is the guidance your GP is likely to be referring to:

https://cks.nice.org.uk/lipid-modification-cvd-prevention#!scenario

And here is an article summarising the debate in medical circles and the evidence informing it:

https://bjgp.org/content/67/654/40

in summary, evidence they reduce death rates is marginal; evidence they prevent heart attacks is stronger, but the chance that any given person will be the one who was going to have a heart attack and didn’t have it because of the statin is small (need to treat 50 people to prevent one heart attack, and nearly 140 people to prevent one death). 

Is that worth the risk of experiencing Side effects? That’s impossible for anyone to answer except you. 

OP ian caton 21 Jan 2020
In reply to hokkyokusei:

That's wild. 

OP ian caton 21 Jan 2020
In reply to no_more_scotch_eggs:

Yes that's true but you give me more info with which to make a choice. Thank you. 

 LeeWood 21 Jan 2020
In reply to ian caton:

Just had a neighbour express dismay over statin prescription. She says they hand them out like smarties ! She gave me a quick resumé of side effects - which will not apply to all - but if they apply to you then a longer lifespan would mean accepting poorer quality of life due to impairment of other body functions. 

Vit K2 helps deal with atherosclerosis.

 mik82 21 Jan 2020
In reply to ian caton:

Your GP has probably done a QRisk2 calculation using your cholesterol and other figures including age and blood pressure.

NICE guidance was changed to recommend anyone with a QRisk more than 10% should be offered a statin. Statistically, you'd only get a 3% reduction in risk, so not that great. Maybe plug your numbers into this and decide whether it's worth the risk of side effects for the small risk reduction.

https://qintervention.org/

In reply to ian caton:

No worries. Statins unfortunately seem to attract a lot of heated debate, not all of it evidence based. As far as I can tell, it’s clearly demonstrated that they prevent deaths in people who have had strokes and heart attacks. It’s their extension to people who have not yet had these events, but are at a higher risk of doing so, and where the benefits for any given individual are not so clear, that has prompted greater debate, including among doctors. But a heart attack or stroke is so potentially devastating that even a small reduction in the risk of one could be seen as worthwhile- provided they aren’t causing unpleasant side effects. In some situations, the evidence of risk vs benefit is pretty finely balanced, and it comes down to the values and attitudes towards medication and risk that the person who is being offered the medication holds. 

I’d suggest reading the articles, and arranging to see your GP again to discuss the matter further. It’s a big commitment, to take a medication for the rest of your life- it’s reasonable to request a bit longer to talk the matter through with a bit more information 

Post edited at 20:40
 patrick_b 21 Jan 2020
In reply to ian caton:

Work it out for yourself if you want - it won't be based solely on your age. 

They'll be using this, or a version of this: https://qrisk.org/three/

 oldie 21 Jan 2020
In reply to nikoid:

> Statins cannot save lives, death can only be delayed. It would be interesting to see some data on the life extending properties of these drugs, I suspect this data hasn't been published as it's pretty unimpressive! <

Surely that might be said about many preventative treatments. If a stroke could kill and statins prevent it or lessen its effects that's usually a positive...have at least a little more life. That said I've decided not to take them myself.

 Becky E 21 Jan 2020
In reply to ian caton:

> Dr recommends I take statins because I am over 60.

> What does ukc think?

> My cholesterol is fine, as is blood pressure. Seems I have a 10.1% chance of a heart attack or stroke in the next ten years. The docs  threshold is 10%. The main, if not only, risk factor is my age.

> Thanks in advance. 

Hi Ian

The risk is calculated using the QRisk score - the latest version is QRisk3 https://qrisk.org/three/ (it factors in more variables than QRisk2, which many GPs are still using).  If you plug your numbers into the calculator you'll see what your risks are, and it will also give you an idea of the expected benefits of statin treatment (assuming you achieve the 40% reduction in LDL cholesterol* that we aim to achieve).

[*LDL = low density lipoproteins aka "lousy" cholesterol.  HDL = high density lipoproteins aka "happy" cholesterol.  Yes, it's naff, but it's how I remember it every time I look at someone's results.]

When considering the risks & benefits of statins (or any other medicine, for that matter), remember that people tend to shout about the bad stuff.  Google any drug and you'll get lots of anecdotal horror stories.  There are lots of people out there happily taking them without any problem.  Until YOU try taking them, you won't know which group you fall into.

Ultimately it comes down to whether or not YOU think that the potential risks and benefits of treatment vs no treatment are worth it.  The national guidelines suggest that we intervene when someone's 10-year risk is >10%, but you might decide to set your threshold higher.  Things to factor in include what your current state of health is like, and how you might feel if that was impaired by a heart attack or stroke.

The other thing to bear in mind is that some people don't get on well with one statin, but are fine when we switch to another.

In the absence of a working crystal ball, I hope that's helpful.

Becky (a pharmacist who has this sort of conversation with patients on a fairly regular basis)

OP ian caton 21 Jan 2020
In reply to Becky E:

Thanks Becky. Really good. 

 oldie 21 Jan 2020
In reply to ian caton:

I'm late 60s. Previously my checkups have given me just a slightly high level of  "good" cholesterol in the blood and everything else good including low blood pressure. Last checkup suggested I might consider statins based on blood tests plus a life style/diet/age questionnare (like you I was given a 10% chance of stroke in next 10 years).

I decided against for the present. This was partly influenced bymy wife who decided to take up the offer at 64. She developed bad memory (couldn't remember people's names or pin she'd had for years) plus muscle pains and fatigue. She stopped and symptoms vanished. Started on a different statin and they returned. My GP is a great believer in statins, while taking them he had a stroke from which he completely recovered....of course this proves nothing...for instance the stroke might have been less debilitating because he was taking them (don't know if he's still taking statins).

FWIW I've read in the popular press that there is an opinion that everyone over a certain age should take statins. For myself I'll wait and see what future experience/research shows unless my risk increases. I usually take everything offered including mole removal, faecal tests, prostate checks, flu and pneumoccal jabs, and am looking forward to my shingles jab at 70 (1 in 4 people get shingles and it can be long lasing and serious)...if I get shingles before then I'll regret not forking out £200 even though its not 100% effective.

 donrobson 21 Jan 2020
In reply to ian caton:

The usual calculation is a version of Qrisk2 - I find it helpful at times to help people make a decision on treatment to see how much difference a modest improvement in their cholesterol, blood pressure etc makes.  I suspect if you were to use the calculator yourself you would find only a small change in your risk from any statin therapy but the decision is yours.

 nikoid 21 Jan 2020
In reply to oldie:

> Surely that might be said about many preventative treatments. If a stroke could kill and statins prevent it or lessen its effects that's usually a positive...have at least a little more life. That said I've decided not to take them myself.

It's definitely a positive if your life is extended by a particular treatment. However for this to happen a large number of people usually need to be treated, most of whom will see no benefit, and a smaller number will suffer harm (from side effects).

OP ian caton 22 Jan 2020
In reply to petemeads:

Can I ask are you a cardiologist, academic in the field or other closely associated professional? Because you make two quite controversial claims that, without any evidence, I struggle to take seriously. 

1. That the combined knowledge of one medical doctor and one non medical doctor outweighs the insight of the NHS and NICE.

2.That the BHF, a charity set up to prolong people's lives, is in essence corrupt.

J1234 22 Jan 2020
In reply to ian caton:

Interesting question, I was speaking with my stroke specialist about just this issue yesterday. 

Doctors like me, I am an interesting case. I had 2 cardiac arrests when I was 40ish and had a pacemaker implanted. I then broke the wires of the PM through being more active than many PM users. I then had a state of the art PM inserted into my heart. I then had two TIAs (mini strokes), the real deal, slurred speech, paralysed down one side, terrifying. The interesting thing was I had one on the right and one on the left which baffled the doctors. I facebooked my cardiologist, who I came to via UKC, who instantly said, you must have a hole in your heart (quite normal circa 25% of the population have one, but not a PM in there to), so now they are looking at closing that up. Thats my medical history.

I was at the Downes hut in late summer and got chatting with a climber I bet a lot of you know and we got to discussing medications and he told me that he had come off statins because they made him weak, hmm, I filed this at the back of my mind.

Last year I tried to get my climbing going again, but was just terrified on the lead, and even seconding I found moves sketchy. I have started to think that my hands are just feeling weak, and that I just have not got hold of anything, I do climb with my feet, but its nice to hold on.

I discussed this with my Cardio, and he suggested I lay off the Stains for a couple of weeks. I noticed an improvement. I then went back on and things went worse. The problem is climbing so much about the mental, is this correlation and cause or whatever.

So yesterday I was speaking to my Stroke specialist, and he said bloody Statins, strange things, we do not really understand them. 
He said lay off them for 4 weeks, keep to your normal diet, not some daft Low Cholesterol on that you cannot maintain in the long term, and then have a Cholesterol test and he will assess, note a specialist is assessing this, not a GP. He said if 5ish, he will be minded to keep me off the Statins, but keep his eye on me. If higher we will experiment with a variety of statins and something else, not a statin, R.... something.

Do remember though that middle class educated chattering class people have been partly responsible for a rise in the case of measles, so take advice from the doctors, but I would try and see a specialist.

Best of luck.

SteveX

 Becky E 22 Jan 2020
In reply to J1234:

Three cheers for a sensible reply! 

 mll2818 22 Jan 2020
In reply to ian caton:

As many people have already said, seeking a second opinion from a specialist seems like the most sensible course of action.

OP ian caton 22 Jan 2020
In reply to J1234:

Thanks for that Steve. Really appreciated. 

 petemeads 22 Jan 2020
In reply to ian caton:

Sorry, none of the above. The two people I respect were examples, not the total, of anti-statin/pro-cholesterol advocates. Please don't struggle on my account, I'm just middle-class educated with an interest in the science as it relates to me...


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