This leaflet is intended to help people who have a history of heart disease and/or have had a stroke or transient ischaemic attack (TIA) in the past. This is called secondary prevention.

What are statins?

Statins are medicines that lower the level of cholesterol in your blood. They help stop the build-up of cholesterol the blood vessel walls that can lead to reduced blood flow or blockages in the vessels that can cause heart disease and stroke.

What are heart disease and stroke?

Heart disease includes heart attacks and angina. Heart attacks happen when the blood supply to the heart muscle is suddenly blocked. Angina is chest pain caused by reduced blood flow to the heart muscle. A stroke can happen when the blood supply to part of the brain is cut off. A short-lived cut in blood supply is called a transient ischaemic attack (TIA), often called a ‘mini-stroke’.

These blockages are often caused by a build-up of cholesterol in the blood vessel walls.

Both conditions need urgent treatment and can be life-threatening.

What are the benefits of statins?

If you have heart disease, statins reduce the risk of a future fatal or non-fatal heart attack by 40%.

Putting it another way, if 100 people with a previous heart attack take a statin for 5 years, 5.8 will avoid a further heart attack compared to those who do not take a statin.

If you have had a stroke or TIA in the past, statins reduce the risk of a future stroke by 15% and a TIA by 26%.

What dose of statin is recommended?

UK guidelines based on scientific consensus recommend that patients who have heart disease or a history of stroke or TIA are prescribed atorvastatin 80mg daily.

What cholesterol level should I be aiming for?

It is recommended to aim for a non-HDL (‘bad’ cholesterol) of less than 2.5 mmol/l. You will be offered an annual blood test as part of your long-term conditions check where this will be monitored.

However, evidence shows that people who have heart disease, stroke or TIA benefit from statins even if their blood cholesterol is normal, as they stabilise the blood vessel walls and make it less likely for existing cholesterol deposits to break off and cause a blockage in the blood supply to the heart or brain.

What are the possible side-effects of statins?

Like all medicines, statins can cause side effects in some people. Most people taking statins will experience no or very few side effects. If you do get problems after starting your statin, please speak to one of our GPs or clinical pharmacists; they can often be reversed by adjusting the dose or changing the type of statin.

Diarrhoea, a headache or feeling sick are side-effects that are usually minor and settle with time.

Muscle pain

Statins can cause muscle pain, but many people get muscle pain from time to time whether they take a statin or not. The diagram below shows the results from many large studies.

More rarely, people can get severe muscle damage. This happens anyway to about 3 in 10,000 people who do not take statins. If all 10,000 people took a statin, on average an extra 3 people would get severe muscle damage and 9,994 would not get severe muscle damage.

If you experience severe muscle pains while taking a statin, please speak to a GP – we would normally arrange a blood test to investigate this further.

Liver

It is recommended that you have a blood test before starting, and 3 months and 12 months after starting a statin. This is because a small proportion (about 4 in 1000) people will have an elevation in some of their liver markers. In the vast majority of cases, this is harmless and usually just requires further monitoring.

There have been some cases of serious liver disease in people who take a statin, but this is so rare that it remains uncertain whether there is a causal effect.

Are there alternatives to statins?

Statins remain the most effective cholesterol-lowering medication available. However if they are not the right medication for you, there are other medications that can be tried. Please speak to a GP or one of our clinical pharmacists who can suggest a suitable alternative.

Of course, lifestyle changes are also very important to reduce your risk of a having another heart attack, stroke or TIA. It is recommended that these are made in conjunction with taking a statin order to minimise your risk as much as possible.

Things to think about include:

• Stopping smoking
• Being more physically active
• Eating a healthy diet
• Maintaining a healthy weight
• Avoiding drinking too much alcohol

One You Haringey provides Haringey residents with a range of free health advice and support to live a healthier lifestyle. This includes weight management courses, exercise classes with health coaches and stop smoking services. You can sign up for FREE at oneyouharingey.org.

What should I do now?

It is important that you make an informed decision about this after reading the leaflet and weighing up the benefits and risks. If you wish to discuss starting a statin, please book an appointment with a GP or one of our practice pharmacists who are more than happy to help.