Statin Information
Patient Information – Cardiovascular Risk Assessment
Why have you been sent this?
We are writing to you as you have an elevated Cardiovascular Risk Score (QRISK) and we recommend you consider taking a cholesterol-lowering tablet and/or making lifestyle changes to keep you healthy and well.
As you may know, the amount of cholesterol in your blood can increase your risk of developing cardiovascular disease (CVD) which includes heart attack, stroke, and peripheral vascular disease. However cholesterol is only one risk factor for CVD and using information from your medical record we can use the QRISK2 tool to calculate the likelihood of you having a stroke or heart attack in the next 10 years. The higher the score, the greater the risk. Also, the more risk factors you have, the greater your risk.
Other risk factors for CVD include:
· Age, gender, ethnicity
· High blood pressure, cholesterol level, body mass index (height and weight),
· Smoking, alcohol intake, diet, sedentary lifestyle
· Medical conditions such as diabetes, rheumatoid arthritis, chronic kidney disease
· Strong family history of heart disease (in relatives under 60 years)
We are writing to you as you have an elevated Cardiovascular Risk Score (QRISK) and we recommend you consider taking a cholesterol-lowering tablet and/or making lifestyle changes to keep you healthy and well.
As you may know, the amount of cholesterol in your blood can increase your risk of developing cardiovascular disease (CVD) which includes heart attack, stroke, and peripheral vascular disease. However cholesterol is only one risk factor for CVD and using information from your medical record we can use the QRISK2 tool to calculate the likelihood of you having a stroke or heart attack in the next 10 years. The higher the score, the greater the risk. Also, the more risk factors you have, the greater your risk.
Other risk factors for CVD include:
· Age, gender, ethnicity
· High blood pressure, cholesterol level, body mass index (height and weight),
· Smoking, alcohol intake, diet, sedentary lifestyle
· Medical conditions such as diabetes, rheumatoid arthritis, chronic kidney disease
· Strong family history of heart disease (in relatives under 60 years)
What does ‘risk’ mean?
Risk is the chance of something happening. It’s important to note your risk of developing CVD is never zero and regardless of other risk factors, your risk naturally increases the older you get.
Your QRISK score will tell you whether you are at low, moderate, or high risk of developing CVD in the next 10 years.
Low risk – QRISK2 score of less than 10% This means that you have less than a one in ten chance of having a stroke or heart attack in the next 10 years.
Moderate risk – QRISK2 of 10-20% This means that you have between a one to two in ten chance of having a stroke or heart attack in the next 10 years.
High risk – QRISK2 score of more than 20% This means that you have at least a two in ten chance of having a stroke of heart attack in the next 10 years.
What can you do to lower your risk?
Guidance from NICE (National Institute for Health and Care Excellence) suggests that anyone with a score of 10% (moderate risk), like yourself, should be offered help to reduce their risk. This includes advice on making lifestyle changes, and we can offer medication to lower cholesterol (statins). As your QRISK rises you can gain increasing benefit from medication.
Risk is the chance of something happening. It’s important to note your risk of developing CVD is never zero and regardless of other risk factors, your risk naturally increases the older you get.
Your QRISK score will tell you whether you are at low, moderate, or high risk of developing CVD in the next 10 years.
Low risk – QRISK2 score of less than 10% This means that you have less than a one in ten chance of having a stroke or heart attack in the next 10 years.
Moderate risk – QRISK2 of 10-20% This means that you have between a one to two in ten chance of having a stroke or heart attack in the next 10 years.
High risk – QRISK2 score of more than 20% This means that you have at least a two in ten chance of having a stroke of heart attack in the next 10 years.
What can you do to lower your risk?
Guidance from NICE (National Institute for Health and Care Excellence) suggests that anyone with a score of 10% (moderate risk), like yourself, should be offered help to reduce their risk. This includes advice on making lifestyle changes, and we can offer medication to lower cholesterol (statins). As your QRISK rises you can gain increasing benefit from medication.
What are statins?
Statins are a group of medications that help to reduce cholesterol and have potential to lower your risk of heart attack and stroke by up to 25%. Atorvastatin is the first-line statin used in the UK. Statins are designed to be taken each day, long-term, and are considered safe. However as with any medication, unwanted side effects can occur -
Muscle aches: Statins have had some bad press and been blamed for lots of muscles aches, stiffness and cramps. The media coverage of statins is unduly harsh and in most cases incorrect. The ASCOT trial with over 10,000 people divided patients into 2 groups – half getting a statin and half getting a placebo (fake tablet). A small number of people in both groups developed muscular pains (2.03% of those taking atorvastatin and 2% of those taking a placebo) in essence there was no statistically significant link between taking a statin and muscular pain. Muscular aches are common and generally not related to statins.
Liver changes: Statin therapy can cause a rise in your liver enzymes (detected on blood tests) in about 3% of people. Generally this is not harmful and may be linked to removing fat from the liver (which is a good thing!) and generally settles with time. Only 3% of that 3% (1 in 1100) people had an ongoing rise in liver tests. About 1 in 100 to 1 in 200 people who start a statin have to stop it due to liver problems but these are rarely serious.
Diabetes: Statin therapy can increase blood sugars and the risk of developing type II diabetes but this generally only happens to those already have raised sugars (pre-diabetes). Despite this we still recommend most people with diabetes take a statin as the benefits of treatment outweigh the risks – our ultimate aim in taking a tablet like a statin is to avoid heart attacks and strokes and statins can be very effective at reducing these risks whether or not a person has diabetes.
Other side effects: Like any drug that has been used commonly and for a long time there are a list of potential side effects, but these are generally mild or uncommon. If you do get a side effect stop the statin medication and the side effect is likely to resolve. If it’s a minor symptom such as a bit of tummy ache or muscular pains it may have nothing to do with the statin at all so if you get a symptom like this after starting your statin, stop it for a month and then try taking it again and if you get recurrent symptoms its likely to be a true side effect. If you are unsure what to do if you get a symptom after starting a statin, please get in contact for a review via our online access form, and select ‘medication queries’.
Statins are a group of medications that help to reduce cholesterol and have potential to lower your risk of heart attack and stroke by up to 25%. Atorvastatin is the first-line statin used in the UK. Statins are designed to be taken each day, long-term, and are considered safe. However as with any medication, unwanted side effects can occur -
Muscle aches: Statins have had some bad press and been blamed for lots of muscles aches, stiffness and cramps. The media coverage of statins is unduly harsh and in most cases incorrect. The ASCOT trial with over 10,000 people divided patients into 2 groups – half getting a statin and half getting a placebo (fake tablet). A small number of people in both groups developed muscular pains (2.03% of those taking atorvastatin and 2% of those taking a placebo) in essence there was no statistically significant link between taking a statin and muscular pain. Muscular aches are common and generally not related to statins.
Liver changes: Statin therapy can cause a rise in your liver enzymes (detected on blood tests) in about 3% of people. Generally this is not harmful and may be linked to removing fat from the liver (which is a good thing!) and generally settles with time. Only 3% of that 3% (1 in 1100) people had an ongoing rise in liver tests. About 1 in 100 to 1 in 200 people who start a statin have to stop it due to liver problems but these are rarely serious.
Diabetes: Statin therapy can increase blood sugars and the risk of developing type II diabetes but this generally only happens to those already have raised sugars (pre-diabetes). Despite this we still recommend most people with diabetes take a statin as the benefits of treatment outweigh the risks – our ultimate aim in taking a tablet like a statin is to avoid heart attacks and strokes and statins can be very effective at reducing these risks whether or not a person has diabetes.
Other side effects: Like any drug that has been used commonly and for a long time there are a list of potential side effects, but these are generally mild or uncommon. If you do get a side effect stop the statin medication and the side effect is likely to resolve. If it’s a minor symptom such as a bit of tummy ache or muscular pains it may have nothing to do with the statin at all so if you get a symptom like this after starting your statin, stop it for a month and then try taking it again and if you get recurrent symptoms its likely to be a true side effect. If you are unsure what to do if you get a symptom after starting a statin, please get in contact for a review via our online access form, and select ‘medication queries’.
What else can you do to lower your risk of heart attack and strokes?
Stop smoking
Smoking is the single biggest modifiable risk factor for CVD, cancer and premature death. Using stop smoking services is three times as effective as trying to do it on your own. If you smoke and want help to stop please seek support via Healthy Cornwall - https://www.healthycornwall.org.uk/make-a-change/smokefree-cornwall/
Manage your blood pressure
Ensuring your blood pressure (BP) is at or below target is really important, and treating high blood pressure can have a major impact on your risk of ill health.
Your target blood pressure is dependent on your age and other factors, and may look as follows when taken on a home BP machine -
Under 80 years old: Below 135/85 mmHg
80 years and over: Below 145/85 mmHg
If you have concerns over your blood pressure, download our Viso App which allows you to send home blood pressure readings to us directly for review -
https://www.staustellhealthcare.co.uk/viso-app.html
Diet and exercise
Consuming a heart-healthy, balanced diet and participating in regular physical activity can reduce your risk of heart disease and other conditions – irrespective of your body weight.
You can make stepwise dietary changes over time which will make a significant impact on your overall risk. Ideas on simple yet effective changes are outlined here - https://www.bda.uk.com/resource/cholesterol.html
The mediterranean dietary pattern is also well known to protect against ill health.
With physical activity you should aim to do at least 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity aerobic activity per week (or a combination of both). Ideally, you should also do strengthening activities twice per week amongst this which further supports cardiometabolic health and reduces risks of sarcopenia (muscle wasting) as you age.
However – something is always better than nothing! So much as a 10-minute walk around the block will benefit your health if you are currently sedentary yet can manage to do this regularly.
If you consume alcohol, stick within safe limits
Men and women are advised not to drink more than 14 units of alcohol per week. Spread your drinking over 3 or more days if you regularly drink.
If you habitually drink higher than recommended amounts and feel you need help in reducing or stopping, please seek support via We Are With You - https://www.wearewithyou.org.uk/services/cornwall-st-austell/
If you are overweight – it can help to lose as little as 5%
It’s difficult to lose weight. However, as little as 5% weight loss can have significant benefits on your CVD risk – IF you are overweight to begin with. Pursuing healthful dietary changes and increasing physical activity as outlined above can sometimes lead to weight loss as a by-product. Focusing on behaviours like these will bring about more success than extreme dieting methods, or unsustainable ways of eating.
For further support with weight loss, lifestyle and getting active please download our Help@Hand App from our social prescribing team:
Apple - https://apps.apple.com/gb/app/help-hand/id1485686894
Google Play - https://play.google.com/store/apps/details?id=sh.mobile.unum.helpathand&hl=en_GB&gl=US
Or visit our app via website if you do not have a smartphone - https://app.hand.community/
If you would like to discuss this further then please contact our social prescribing team on 01726 626844.
Stop smoking
Smoking is the single biggest modifiable risk factor for CVD, cancer and premature death. Using stop smoking services is three times as effective as trying to do it on your own. If you smoke and want help to stop please seek support via Healthy Cornwall - https://www.healthycornwall.org.uk/make-a-change/smokefree-cornwall/
Manage your blood pressure
Ensuring your blood pressure (BP) is at or below target is really important, and treating high blood pressure can have a major impact on your risk of ill health.
Your target blood pressure is dependent on your age and other factors, and may look as follows when taken on a home BP machine -
Under 80 years old: Below 135/85 mmHg
80 years and over: Below 145/85 mmHg
If you have concerns over your blood pressure, download our Viso App which allows you to send home blood pressure readings to us directly for review -
https://www.staustellhealthcare.co.uk/viso-app.html
Diet and exercise
Consuming a heart-healthy, balanced diet and participating in regular physical activity can reduce your risk of heart disease and other conditions – irrespective of your body weight.
You can make stepwise dietary changes over time which will make a significant impact on your overall risk. Ideas on simple yet effective changes are outlined here - https://www.bda.uk.com/resource/cholesterol.html
The mediterranean dietary pattern is also well known to protect against ill health.
With physical activity you should aim to do at least 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity aerobic activity per week (or a combination of both). Ideally, you should also do strengthening activities twice per week amongst this which further supports cardiometabolic health and reduces risks of sarcopenia (muscle wasting) as you age.
However – something is always better than nothing! So much as a 10-minute walk around the block will benefit your health if you are currently sedentary yet can manage to do this regularly.
If you consume alcohol, stick within safe limits
Men and women are advised not to drink more than 14 units of alcohol per week. Spread your drinking over 3 or more days if you regularly drink.
If you habitually drink higher than recommended amounts and feel you need help in reducing or stopping, please seek support via We Are With You - https://www.wearewithyou.org.uk/services/cornwall-st-austell/
If you are overweight – it can help to lose as little as 5%
It’s difficult to lose weight. However, as little as 5% weight loss can have significant benefits on your CVD risk – IF you are overweight to begin with. Pursuing healthful dietary changes and increasing physical activity as outlined above can sometimes lead to weight loss as a by-product. Focusing on behaviours like these will bring about more success than extreme dieting methods, or unsustainable ways of eating.
For further support with weight loss, lifestyle and getting active please download our Help@Hand App from our social prescribing team:
Apple - https://apps.apple.com/gb/app/help-hand/id1485686894
Google Play - https://play.google.com/store/apps/details?id=sh.mobile.unum.helpathand&hl=en_GB&gl=US
Or visit our app via website if you do not have a smartphone - https://app.hand.community/
If you would like to discuss this further then please contact our social prescribing team on 01726 626844.
Next steps
We recommend starting atorvastatin but have not prescribed as yet. If you have reviewed the above, considered your options and decided to accept or decline a statin – please let us know via response to the text message sent to you.
If you wish to start a statin, a prescription will be issued within 3 working days and a text alert sent to inform you. You will need a blood test to assess your cholesterol and liver function 3 months after starting it. There is no need to re-assess your QRISK after this.
If you don’t wish to start a statin, we will update your records accordingly with your decision.
With best wishes from the team at St Austell Healthcare.
Useful websites for more information:
British Heart Foundation – “Statins” - https://www.bhf.org.uk/informationsupport/treatments/statins
British Heart Foundation - “How do I lower my cholesterol? Your top 5 questions answered” - https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol/five-top-questions-about-lowering-cholesterol
NICE Patient Decision Aid – “Should I take a Statin?” https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159
Got a query? Get in touch with us online –
https://access.klinik.co.uk/contact/st-austell-healthcare-group/
We recommend starting atorvastatin but have not prescribed as yet. If you have reviewed the above, considered your options and decided to accept or decline a statin – please let us know via response to the text message sent to you.
If you wish to start a statin, a prescription will be issued within 3 working days and a text alert sent to inform you. You will need a blood test to assess your cholesterol and liver function 3 months after starting it. There is no need to re-assess your QRISK after this.
If you don’t wish to start a statin, we will update your records accordingly with your decision.
With best wishes from the team at St Austell Healthcare.
Useful websites for more information:
British Heart Foundation – “Statins” - https://www.bhf.org.uk/informationsupport/treatments/statins
British Heart Foundation - “How do I lower my cholesterol? Your top 5 questions answered” - https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol/five-top-questions-about-lowering-cholesterol
NICE Patient Decision Aid – “Should I take a Statin?” https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159
Got a query? Get in touch with us online –
https://access.klinik.co.uk/contact/st-austell-healthcare-group/