Statins - would you push for them?

[Troubler]

I have high cholesterol. My dad has genetic high cholesterol (familial HC) and my mum had a heart attack when she was 66.

I recently had a blood test for work insurance and they cut back my life cover through work because my cholesterol was high.

but when I went to the GP, he said my Q risk score was low and therefore I didn’t need statins.

Is it worth trying to get them? My family who live abroad are quite horrified that I haven’t got them given all the heart issues in my family but the GP was adamant he wasn’t going to prescribe them unless I had other risk factors which apparently I don’t!

I’m guessing I would have to go private to get them as the NHS GP is adamant I don’t need them

See a different GP. Get them to explain your cholesterol results. The crucial bit is not simply the overall number, but the LDL (“bad” cholesterol) figure and also the ldl to hdl (“good” cholesterol) ratio.

Assuming there is no happy surprise that you in fact have very high good cholesterol only, yes you need statins.

I have familial HC. I started on statins in my late 30s/early 40s and it has worked. Nothing else ever worked. While I am taking statins, not only is my cholesterol under control, but the actual plaque in my arteries is stabilised so less likely to have a stroke because of some breaking off.

that was only recently explained to me. I avoided them for years but now am converted…

Thanks - I will try and find another GP. What is frustrating is that it’s obviously high enough that I now can’t get ‘full” life insurance yet I can’t get treatment for it!

I would also ask for a referral to a geneticist, as I have high cholesterol courtesy of my father... this consultant was incrediblyhelpful as he changed my medication and my levels. Mind you, I did have a TIA, which might have sped up the referral!

There’s nothing in the world that makes me think that statins are a solution to anything. They are not good news.

First thing first, what do you call high cholesterol? Mine was over 11 before meds.

Second thing second, LDL is not all bad. Large LDL particles are healthy, small LDL particles are unhealthy. No chance you’ll get an LDL-p particle size test on the NHS though, you’d have to go private.

If you do have high LDL and genetic factors such as FH then yes you likely should be on statins and/or ezetemibe.

In the mean time you could take matters into your own hands and try a Berberine supplement. I’m on 80mg Atorvastatin. I found that for me a Berberine supplement and 40mg Atorvastatin were about the same as 80mg Atorvastatin.

The higher the dose of a statin the less the cholesterol reduces per mg - let’s say 80mg brings it down by 6, 40mg brings it down by 4 - but 40mg statin + Berberine brings it down by 6.

I’m also on Ezetemibe as the NHS want mine to be below 2.6

I had to go private for a CT Angiogram to put my mind at rest (result = no soft dangerous plaque, only hard stable stuff).

Make sure you are getting enough Omega3s btw, and if you do get on a statin make sure to take Magnesium, CoQ10 and TUDCA to offset potential side-effects.

Heart attacks are even worse news than muscle cramps… I know because I had one. I have no ill side-effects with statins except the fact that Atorvastatin raises blood sugar levels (think the opposite of Mountjaro).

One of the best things about statins is the way they reduce inflammation - very useful even without cholesterol issues - but more modern statins like Pitavastatin or Rosuvastatin are best for this and only need a very small dose.

I am.on my third month.

Cholesterol was not going down and stuck at 6.5 having come down from 6.9.

After 2 months gone down to 5.7.

not over weight and reasonably active. Next check up in Jaunuary.

I don’t want to take them in any account. I would be interested to know what else others have tried to reduce cholesterol.

Your GP needs to update themselves. QRISK is only a guide and tbh it’s pretty shit.
The thinking now is that if lipids are raised to give a statin even if qrisk is low plus it massively underestimates risk if you are young.
Ideally your LDL needs to be lower than 2.
I would have been recommending a statin to you due to raised lipids and family history.
Tell them you want them.

Definitely go back to another GP and quote this from the NICE guidelines:

“Do not rule out treatment with atorvastatin 20 mg for the primary prevention of CVD just because the person's 10‑year QRISK3 score is less than 10% if they have an informed preference for taking a statin or there is concern that risk may be underestimated. [May 2023]”

Mine is high also, but I have very good ldl/hdl ratio and triglygerides are also very good. I have bile duct issue so statins are not good for me liver wise. Doc is not concerned at all, but to put my mind at rest I got a calcium CT scan. This identifies plaque in the arteries, and I got a zero score, the best there is. I'm 60 plus now and will not take statins even if the LDL increases. There is a lot of talk of statins contributing to dementia, so I don't want to risk that on balance.

I was diagnosed with FH at the age of 12. I’ve had three decades of trying to reduce with lifestyle factors: avoiding animal fats, taking benecol type supplements etc. 20 years of endocrinologist supervision at the stroke clinic; a lot of tweaking my other vitamin and hormone levels as well as nutritional advice, food diaries etc. Lots of exercise (running, swimming, cycling, yoga/pilates, daily). Cutting out alcohol. Cutting out all refined carbs, etc etc etc.

For people with FH - which the OP may well have, she needs to investigate - the only proven method to reduce cholesterol significantly enough to reduce risk is statins.

I take activation and ezetimibe and they halved my cholesterol within weeks.

*Atorvastatin, not activation

Also. Statins reduce the risk of dementia, particularly Alzheimer’s but also vascular.

Seconding what wtftodo says, I have FH from at least three generations prior, all of whom have died in their 50s/60s of heart attacks.

People saying "oh statins are baaaad" apparently aren't capable of comparing minor side effects (if any, I don't) to being fucking dead.

With FH and a number of other illnesses, cholesterol levels are elevated by otherwise normal organ function and can't be reduced usefully by diet at all. Statins and ezetemibe may mean I'll buck the family trend and last into old age.

Are you a cardiologist?

Statins also benefit stroke risk. As someone who had one early, I’d recommend against the risk!

I would and have pushed for statins.

Similarly to @wtftodo , I was young when I started pushing to even check my cholesterol (early 20s probably), due to a very strong family history of death from heart attacks at young ages, and yes, FH.
It was high, and my lifestyle was good, but GP insisted on lifestyle interventions anyway 🙄 After a couple of years i went to a different GP, cholesterol still high, and he was horrified i wasn't on statins already. Statins worked very quickly, and have for about 15 years.
This year I wanted to go to the cardiologist for a check up (medicated for high BP as well), and my cholesterol was good for a low risk person, a little high for a high risk person, so he added ezetimibe.
I haven't had another check yet, but he was confident in this regime.

I've never had any side effects or anything. And I'd really rather not die from a heart attack, so I am more than happy to take meds.

Did you definitely mention that your parent has fh to the Dr?
I did with mine, last week, and she took it very seriously. I'd have been referred to a lipid clinic for genetic testing if my cholesterol was anything to worry about (it's actually low so we'll revisitI a year.

I'd contact them again, in writing, stating that you're concerned due to the FH, your mum's history and your cholesterol score and just want to check that they did in fact fact hear what you had said.

DH had high cholesterol and spent a year trying to reduce it by diet and lifestyle. Made only a tiny, tiny difference. Went on statins and it plummeted. His grandfather died of heart attack in his 50s. DH also had high BP so it was a no brainer really. Zero side effects.

I resisted strongly because there are so many drugs I have to take for other conditions in order to function that I didn't want to add another. My cholesterol was low but I had a high qrisk score. I eventually agreed to a low dose. My cholesterol went down even lower and I had zero side effects. The same can't be said of any of the other drugs I take.

I’ve been checked for FH as a child and apparently don’t have it and I did tell the GP that

my cholesterol was 8.2 for the insurance test (non Hdl was 5.6) but that was non fasting

I paid for a test myself (a fasting one) and it was 6.8 (non hdl 4.4)

I have FH and was reluctant to start statins but no amount of dietary or lifestyle changes made any difference. I started with really high cholesterol levels and within 6 weeks it was down to 3.3. It's been at 3.3 for the past 12 years. It should be lower but I take the lowest dose I can get away with. The arcus cornealis took a few months longer to disappear but my eyes look normal now.
I had a very high score on the Dutch Lipid Clinic Network criteria and starting statins was the best thing I ever did.

@Fgfgfg I didn't realise that it was possible for the arcus cornealis to disappear once formed, that's interesting to hear. Can I ask what statins you are on?

Do people not lower cholesterol by diet in the UK? I had high cholesterol here in Mexico and was told to adjust my diet. These threads are just advertising for drugs

You can't lower familial cholesterol with diet.

I have been on statins for 5 years now, purely precautionary due to family history of both cardiac problems and dementia. My GP said they cost about £1 a week and he thought I was worth a £1 a week 😅

My cholesterol has gone from 5.2% (which was fine anyway) to 3.4%.