THIS week, Dr Zak discusses the benefits over the risks of taking statins.

Recent research conducted at Oxford University has shown that patients without heart disease may benefit from statin therapy.

The authors analysed data from just over 120,000 patients, with an average age of 61, and a male to female ratio of six to four.

They demonstrated that for every 10,000 patients taking a statin, 36 adverse events were prevented, these being 19 fewer heart attacks, nine fewer strokes, and eight fewer deaths from heart disease.

On the opposite side of the coin, for the same number of patients, 41 more side effects were noted; 15 reports of muscle pain, 12 kidney complaints, and 14 eye conditions.

From this they concluded that potential harms were small, and benefits outweighed risks.

The statin debate is not new, having rumbled on for decades. Statins are one of the most prescribed medications worldwide. Advocates for their use have gone as far as to suggest a blanket application for everyone over 50.

Those against bemoan that ageing has become seen as a medical condition rather than a normal phenomenon, as well as highlighting the multiple complaints from patients prescribed statins.

There is a slightly increased risk of developing type two diabetes with the drugs.

Studies have argued both ways as to whether they increase the risk of or prevent cognitive decline and dementia.

Statins lower the level of LDL or “bad cholesterol”.

This molecule transports fat from the liver to the arteries, depositing it in their walls, causing narrowing and eventually blockages. HDL or “good cholesterol” does the opposite.

Statins are offered in two distinct scenarios.

When a person has survived a cardiovascular event, that being a heart attack, transient ischaemic attack (TIA) or stroke, a high dose preparation is prescribed to reduce the risk of a further event.

This application is well established and has rarely courted controversy.

The provision of statins as primary prevention is for those individuals who have not had an event, but whose risk profile puts them at greater risk.

Risk profile is made up of several indices including age, blood pressure, body mass index (BMI), presence of absence of diabetes, smoking status, and total cholesterol as well as the levels of good and bad cholesterol relative to each other.

Previously statin therapy was advised if your risk of an event in the next ten years, known as the “Q-risk” was 20 per cent or more.

This advice has now been modified, with the National Institute for Health and Clinical Excellence (NICE) opining that a low dose statin should be offered in addition to lifestyle modification, or where such measures are either inappropriate or have proved ineffective for anyone with a risk of 10 per cent or more.

A significant drawback is that if you have two individuals with the same risk profile, yet one is 40 and the other 60, the Q risk will be much greater for the older individual.

The weighting given to age alone is such that a 40-year-old with a very elevated cholesterol may have a risk factor in low single figures, yet a 60-year-old with a normal lipid profile may have a risk percentage in the high twenties.

Raised Q risks are seen in older individuals with normal cholesterol levels.

This may lead to a false sense of security in the younger age group where important lifestyle modifications clearly need to be made, yet blind panic in an older population living a very healthy existence.

The side effects caused by statins, or at least felt to be caused by statins, are wide ranging, and such that several abandon them or else persevere with great disability and pain.

The nocebo effect demonstrates that individuals in a trial report side effects if they believe they are on a statin, irrespective of whether they are taking the active drug or a placebo.

Yet despite this, GPs spend a lot of time addressing reported side effects of statins, requesting investigations, and switching between preparations to try to reduce patients’ symptoms.

Compliance among those prescribed medications where there is a clear indication is often low, so convincing everyone to take something “just in case” doesn’t seem like a rational approach.

Of importance is getting your cholesterol checked routinely for those 40 or over, or at a younger age in persons with a strong family history of cardiovascular disease (CVD).

Clearly statins have a place as part of an overall management strategy.

Addressing all risk factors, while equally promoting the benefits of a healthy lifestyle, which thankfully comes without side effects, is key to good health.