What are statins and what do they do?
Statins are tablets used in the treatment of hyperlipidaemia (high fat levels in the blood). They can reduce LDL (‘bad’) cholesterol and produce a slight increase in HDL (‘good’) cholesterol.
Cholesterol is a type of fat produced by the liver. We also get a small amount from our diet. Cholesterol is found in everyone’s blood, but people with diabetes can have higher amounts of it. HDL, or ‘good’ cholesterol, carries cholesterol away from the blood vessels to be broken down by the body. LDL, or ‘bad’ cholesterol, can slowly build up in the blood vessels, together with other substances, and form a blockage. A high LDL cholesterol level is a risk factor for cardiovascular disease (which includes heart disease and stroke).
Statins can also reduce triglycerides (simple fats stored in the body tissues). High levels of triglycerides are associated with an increased risk of coronary heart disease.
What lipid levels would indicate hyperlipidemia?
People with diabetes should get their blood fats checked at least once a year, as part of their annual review.
Ideally total cholesterol levels should be below 4mmol/L. Total cholesterol includes HDL and LDL cholesterol. Considered individually, then HDL cholesterol should be 1.0mmol/L or above for men, 1.2mmol/L or above for women, and LDL cholesterol should be below 2.0mmol/L.
Your fasting triglyceride should ideally be below 1.7mmol/L.
I don't have hyperlipidemia. Why am I being prescribed statins?
People with diabetes are between two to four times more likely to develop cardiovascular disease than someone without diabetes. Cardiovascular disease is disease of the heart and circulatory system and includes coronary heart disease and stroke.
Recent research has shown that prescribing statins can reduce rates of cardiovascular disease in people with diabetes, even amongst those considered to have a ‘low’ cholesterol level. Your healthcare professionals will be aware of this research and are taking a preventative approach, to reduce your risk of heart attack and stroke.
Are statins suitable for everyone?
Statins should be used in caution in people who have had liver disease or who have a history of high alcohol intake. Before starting treatment with statins, and within one to three months after starting, a blood test to examine the function of the liver should be carried out. After this time, the test should be undertaken at six monthly intervals for a year, unless there are signs or symptoms of liver problems, in which case the frequency of tests should be increased. Anyone experiencing unusual indications of muscle pain, tenderness or weakness should report this immediately to their doctor.
Statins should not be used during pregnancy or in women who are breast-feeding. You should also discuss with your doctor whether or not statins are compatible with other medications you might be taking.
What are the side effects of statins?
There are different types of statins available in the UK, including:
- atorvastatin (Lipitor)
- fluvastatin (Lescol)
- pravastatin (Lipostat)
- rosuvastatin (Crestor)
- simvastatin (Zocor).
You will need to talk to your care team or read the insert that comes with your medication, to find out what the possible side effects may be with the ones you are taking.
Statins can cause headaches, altered liver function tests and stomach problems, including abdominal pain, flatulence, diarrhoea, feeling sick and vomiting. Statins may sometimes be associated with depression, sleep disturbances, memory loss and sexual dysfunction.
Rare side effects can also include reversible myositis (inflammation of the muscle tissue), rashes and hypersensitivity reactions.
Interstitial lung disease is a very rare adverse effect of statins. If you develop any features of interstitial lung disease such as shortness of breath, non-productive cough and deterioration in general health (eg fatigue, weight loss and fever) you should report this to your doctor promptly.
Is there anything else I can do to reduce my cholesterol?
Some people need to take statins or other medications in order to bring down their cholesterol level and reduce their risk of cardiovascular disease. But there are other things you can do alongside taking your medication, which can also help to lower your cholesterol level. These include:
- Restricting your saturated fat intake (eg full fat milk, cheese, butter, ghee, meat, coconut, chocolate, cakes and biscuits). Choose monounsaturated fats instead, eg olive, rapeseed and groundnut oil.
- Eating more fruit and vegetables, as well as oats, beans and pulses
- Regular physical activity
- Losing any excess body weight