No proof Earl Grey can fight heart disease

reposted from: http://www.nhs.uk/news/2014/04April/Pages/Earl-Grey-unproven-as-replacement-for-statins.aspx

crabsallover highlights, key points, comments / links.

A cup of Earl Grey 'as good as statins' at fighting heart disease,” reports The Daily Telegraph, entirely without proof.

The science behind this headline did not show Earl Grey was as good as statins (a class of drugs used to lower high cholesterol) in people.

The study was early stage research on a small group of rats in a laboratory. None of the research involved humans, tea, or any assessment of heart disease.

The research involved an extract called HGMF, taken from the bergamot fruit; a citrus fruit used to flavour teas such as Earl Grey.

Rats with high cholesterol levels were fed a high cholesterol diet for three weeks and given either the bergamot extract (HMGF) or the commonly used statin, simvastatin.

The researchers found that HMGF had cholesterol-lowering effects similar to that of simvastatin. Though importantly, as the research was in rats, it is not possible to say that HGMF would work the same way in humans, unless directly tested.

Furthermore, this study tested a pure extract rather than tea containing the extract, the effects of which may be different. For instance it is unclear how much Earl Grey you would need to be exposed to a comparable level of HGMF; it may take gallons of the stuff.

This study is absolutely not a reason to stop taking prescribed statins to replace them by drinking Earl Grey tea as this could be dangerous.

Where did the story come from?

The study was carried out by researchers from the University of Calabria (Italy) and was funded by the Italian National Project.

The study was published in the peer-reviewed Journal of Functional Foods.

The Daily Telegraph and the Mail Online reporting was potentially misleading and arguably irresponsible.

While the main body of the article was factually accurate, the headlines (one of which was on the front page of the Telegraph) implied that drinking Earl Grey tea had been proven to be as effective as statins.

Statins are known to be effective and have a large weight of evidence from human research proving this. By contrast, the effects of Earl Grey tea, as far as we are aware, have barely been researched, so they are not on an equal playing field. So suggestions that Earl Grey is “just as effective” are unfounded.

This could have encouraged people who had been prescribed statins, some of which are at high risk of experiencing a cardiovascular disease such as a heart attack or stroke, to stop taking their medication.

What kind of research was this?

This was an animal study looking at the effect of bergamot extract on the cholesterol profile of rats with high cholesterol and comparing it with a commonly used statin called simvastatin.

Statins are a class of related drugs currently used to lower cholesterol levels in people at risk of cardiovascular disease, the main cause of death in many westernised countries. The drugs lower cholesterol levels by acting on an enzyme called 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) in the body.

The researchers were looking to see if other compounds might work in a similar way to statins and affect the same enzyme. They decided to investigate bergamot (Citrus bergamia Risso), a citrus fruit widespread in the Mediterranean area.

The fruit has anecdotal cholesterol-lowering properties and the study authors said it was only toxic at very high levels, implying it might be relatively safe. The researchers state bergamot essence is used in teas, jams and sherbet, but there was no special mention of Earl Grey in the underlying research. It appears the media has made a link with this specific tea as it apparently contains high levels of the extract and is well known to a UK readership.

What did the research involve?

The study used 48 rats with high cholesterol to compare the cholesterol-lowering effects of bergamot extract 3-hydroxy-3-methyl-glutaryl flavanones (HMGF) with the commonly-used statin, simvastatin. The rats’ diets were carefully controlled so all that differed was their cholesterol treatment – bergamot or statin.

Body weight, blood cholesterol levels, cellular protein levels, liver enzyme activity and genetic regulatory mechanisms were all monitored and recoded for evidence of cholesterol-lowering properties in the different treatment groups.

Contrary to the headlines, the experiments involved a dry extract from bergamot fruit peel. Unfortunately for the rats they did not get to sample any tea, Earl Grey or otherwise. 

The important measures were total cholesterol, another type of blood fat (triglycerides), and specific subtypes of cholesterol called very low density lipoproteins (VLDL), low-density lipoproteins (LDL) and high-density lipoproteins (HDL). HDLs are the so called “good” cholesterol, whereas LDLs are the “bad” cholesterol. This is a simplistic account of their roles within the body, but is sometimes useful.

Before the experiment all rats were stabilised on regular rodent food before being randomly divided into four groups of 12 animals each:

• control group: received a regular diet for three weeks
• high cholesterol control group: received a high cholesterol diet for three weeks (regular diet +2% cholesterol +0.2% cholic acid; a bile acid that has a role in fat absorption and moderating cholesterol levels)
• high cholesterol group treated with statin: received the high cholesterol diet for three weeks (regular diet +2% cholesterol +0.2% cholic acid); from the 2nd to the 3rd week each rat was given simvastatin (20 mg/kg bodyweight/day) 
• high cholesterol group treated with bergamot extract HMGF: received the high cholesterol diet (regular diet +2% cholesterol +0.2% cholic acid) for three weeks; from the 2nd to the 3rd week each rat was given HMGF (60 mg/kg bodyweight/day

The main analysis compared the cholesterol lowering effects of simvastatin with the bergamot extract HMGF.

What were the basic results?

Both the bergamot extract and simvastatin reduced total cholesterol (in blood and in the liver), triglyceride levels, and VLDL and LDL levels – the bad cholesterol. However, an increase in HDL content – the good cholesterol – was observed exclusively in the HMGF-treated rats.

Both bergamot extract and simvastatin regulated enzymes were involved in cholesterol metabolism in a similar way at a protein and gene regulation level. This implied the changes observed were not coming from some other secondary effects of the extract and were direct result of changes to how cholesterol was metabolised in the rats’ livers.

The study investigated the safety of the extract to some degree. It found the extract had a low toxicity to cells in the body, and did not cause DNA damage at doses lower than 90 micrograms per millilitre.

How did the researchers interpret the results?

The researchers stated that their study “demonstrated that the three statin-like flavanones, extracted from bergamot peel and contained in HMGF, exert a similar behaviour [in] respect to commercial simvastatin on a model of hypercholesterolaemic rats [rats with high cholesterol levels]” and that “the daily supplementation of HMGF in the diet could be very effective for the treatment of hypercholesterolaemia”.

Conclusion

This animal experiment indicated that the bergamot extract HMGF may have cholesterol-lowering effects similar to that of the commonly used statin, simvastatin, when given to mice with high cholesterol levels that were fed high cholesterol diets for three weeks.

The main limitation of the study was that none of the research involved humans. Therefore, it is not possible to say the bergamot extract would work the same way in humans, unless directly tested. Furthermore, this rat study tested a pure extract rather than tea containing the extract, the effects of which may be different. For instance, taking milk in tea could potentially affect how the extract is metabolised in the body compared to a pure extract.

The headlines indicated Earl Grey tea could help fight heart disease, but based on the underlying research study only, there is little evidence for that. Also the study made no assessment of the long-term health benefits of the reductions in cholesterol in the rats. For example, the effects may have been temporary.

There needs to be more robust research in humans to find out if bergamot extract holds any real promise in lowering cholesterol levels and so fighting cardiovascular diseases such as heart disease and strokes in the future.

We would not want anyone to think this research is a reason to stop taking statins and replace them with drinking tea containing bergamot extract; this could potentially be dangerous. If you have any concerns about your cholesterol levels, or any cholesterol-lowering treatments that you are currently prescribed, consult your doctor.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines

A cup of Earl Grey 'as good as statins' at fighting heart disease, study finds. The Daily Telegraph, March 30 2014

Earl Grey, the brew that could tackle heart disease: Scientists say bergamot found in the tea could be as effective as statins in controlling cholesterol. Mail Online, March 31 2014

Links to the science

Di Donna L, Iacopetta D, Cappello AR, et al. Hypocholesterolaemic activity of 3-hydroxy-3-methyl-glutaryl flavanones enriched fraction from bergamot fruit (Citrus bergamia): “In vivo” studies. Journal of Functional Foods. Published online February 1 2014

JBS3 Report

reposted from: http://www.jbs3risk.com/pages/report.htm

crabsallover highlights, key points, comments / links.

Recommendations from each section

General Recommendations

• Use JBS3 risk calculator to estimate both 10-year risk and lifetime risk of CVD in all individuals except for those with existing CVD or certain high risk diseases i.e. diabetes age >40 years, patients with chronic kidney disease (CKD) stages 3-5, or familial hypercholesterolaemia (FH).
• Total cholesterol and HDL-cholesterol from a non-fasting blood sample should be used for lipid profile estimate of CVD risk in the JBS3 calculator
• Non-HDL-cholesterol, measured from a non-fasting blood sample as total cholesterol minus HDL-cholesterol, should be used in preference to LDL-cholesterol as the treatment goal for lipid-lowering therapy.
• Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy in patients with existing CVD, without the need for estimation of CVD risk.
• Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy, in individuals at particularly high risk of developing CVD: i.e. diabetics age >40 years, patients with CKD stages 3–5, or FH without the need for estimation of CVD risk.
• Diet, lifestyle intervention and pharmacological therapy in people at high short-term risk. Thresholds for treatment with statins based on 10-year CVD risk will be informed by NICE guidelines.
• Diet, lifestyle intervention and for some people, pharmacological therapy, in those with increased modifiable lifetime risk as informed by JBS3 calculator metrics.

2. Lifestyle Recommendations

Smoking

• Professional support on how to stop smoking should be given, at every available opportunity, with provision of self-help material and referral to more intensive support, e.g. stop smoking services.
• The JBS3 risk calculator emphasises the benefits for early smoking cessation and the diminishing but still substantial returns for quitting at an older age.
• Patients should be offered behavioural counselling, group therapy, pharmacotherapy or a combination of treatments that have been proven to be effective.
• Nicotine replacement therapy (NRT), varenicline or bupropion should be offered to people who are planning to stop smoking as part of an abstinent-contingent treatment in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date).
• People who have heart or respiratory diseases, and those who live with them, should be made aware of the risks of both active and passive smoking (second-hand smoke).
• For specific recommendations on quitting smoking in pregnancy and following childbirth, see NICE public health guidance 26.
• The importance of stopping smoking during pregnancy should be emphasized and guidance from the National Institute for Health and Clinical Excellence (NICE) followed.[1]

Diet
Professional support to consume a diet associated with the lowest cardiovascular risk should be provided based on the following principles:

• Intake of saturated fat to <10% of total fat intake (preferably in lean meat and low-fat dairy products)
• Replace saturated fat with poly-unsaturated fat where possible
• Consume five portions per day of fruit and vegetables
• Consume at least two servings of fish (preferably oily) per week
• Consider regular consumption of whole grains and nuts
• Keep salt consumption <6 g per day
• Limit alcohol intake to <21 units per week for men and <14 units per week for women
• Avoid/reduce consumption of:
  • Processed meats or commercially produced foods which tend to be high in salt and trans fatty acids
  • Refined carbohydrates, such as white bread, processed cereals
  • Sugar-sweetened beverages
  • Calorie-rich, but nutritionally poor snacks, such as sweets, cakes and crisps
• Children and young people should be supported to consume a diet based on the same principles.

Physical activity and exercise

• An increase in overall levels of sustained physical activity and avoidance of prolonged sedentary behaviour are important for reduction of CVD risk.
• Emphasise walking, cycling and other aerobic physical daily activities, at moderate intensity, as part of an active lifestyle, for at least 150 minutes per week in bouts of ≥ten minutes, or 75 minutes per week of vigorous physical activity, or a combination of the two.
• Muscle-strengthening activities performed on at least two occasions per week

Exercise training
General population and those at low to moderate risk of CVD:

• Exercise training, incorporating a warm up and cool down period, should be performed at moderate to high intensity two to three times per week for 30 to 40 minutes each time.
• The mode of exercise should be aerobic and, where possible, continuous allowing for a steady progression in effort, e.g. walking programmes, cycling, jogging, swimming.
• The time spent exercise training contributes to meeting the 150 minutes per week physical activity recommendation (as above).

Patients with established CVD and those considered at higher risk of CVD:

• A more structured approach is needed in managing patients and in all cases, assessment and specific goal setting, with risk stratification, delivered by professionals skilled in health-related exercise is preferable.
• Exercise on referral and community-based exercise initiatives are recommended for patients at risk of CVD.
• Cardiac rehabilitation programmes are recommended for patients with established CVD and in those following a CVD event.

3. Childhood and Adult Obesity Recommendations

• Multidisciplinary approaches to obesity management in children and young people are required with a 'lifetime risk' message. These include interventions during the early post-partum period as well as regular monitoring of childhood weight and family counselling.
• With appropriate training all health care professions should be able to Ask and Assess adiposity and Advise appropriate adult patients on evidence based ways to target weight change.

4. Lipid Recommendations

• Non-fasting blood samples should be taken to measure total cholesterol (TC) and HDL-cholesterol. The JBS3 risk calculator enables entry of these two measures and it is expected that non-HDL-c (TC minus HDL-c = non-HDL-c) will gradually replace LDL-c in clinical practice as well as in clinical trials.
• All high risk people should receive professional lifestyle support to reduce total and LDL-c, raise HDL-c, and lower triglycerides to reduce their CVD risk.
• Cholesterol-lowering drug therapy is recommended in:
  • Patients with established CVD
  • Individuals at particularly high risk of CVD: diabetes age > 40 years, patients with CKD stages 3-5, or FH
  • Individuals with high 10-year CVD risk (threshold to be defined by NICE guidance)
  • Individuals with high lifetime CVD risk estimated from heart age and other JBS3 calculator metrics, in whom lifestyle changes alone are considered insufficient by the physician and person concerned
• Statins are recommended as they are highly effective at reducing CVD events with evidence of benefit to LDL-c levels <2 mmol/L which justifies intensive non-HDL-c lowering.
• Statins are safe with trial evidence showing no effects on non-cardiovascular mortality or cancer. There is a small increase in risk of developing diabetes but the benefits of cholesterol lowering greatly exceed any risk associated with diabetes. If statin intolerance develops a stepwise strategy involving switching agents and re-dosing is recommended.
• Despite low HDL-c levels contributing to CVD risk, drug therapy to raise HDL has not been shown to reduce CVD risk and is not currently indicated.

5. Blood Pressure Recommendations

• Hypertension should be suspected when office BP is persistently elevated, i.e. ≥140/90mmHg.
• Ambulatory BP monitoring (ABPM) is recommended to confirm the diagnosis of hypertension (Daytime mean ABPM ≥135/85mmHg).
• All high risk people should receive professional lifestyle support to reduce their blood pressure which may avoid the need for, or complement the use of, drug therapy for hypertension and reduce CVD risk.
• People with an office BP >160/100 mmHg, an 24-hour day time ABPM average or home APBM average of >150/95 mmHg (stage 2 hypertension) should be offered pharmacological therapy to reduce BP.
• People with an office BP >140/90 mmHg, but <160/100 mmHg, a 24-hour daytime ABPM average or home APBM average of >135/85 mmHg (stage 1 hypertension) and established CVD, hypertensive target organ damage, diabetes, CKD, or a high lifetime risk assessed by JBS3 calculator, should be offered pharmacological therapy to reduce BP.
• People with stage 1 hypertension without established CVD, hypertensive target organ damage, diabetes, CKD, or a significant increase in lifetime risk assessed by JBS3 calculator, should receive advice on lifestyle interventions and be scheduled for annual BP and lifetime risk assessment to inform future need for therapy.
• Pharmacological treatment for patients with hypertension should follow the current NICE guidance (CG127) treatment algorithm:
  • Patients <55 years of age should be offered an ACE inhibitor or ARB as preferred initial therapy
  • Patients aged ≥55 years should be offered a Calcium Channel Blocker (CCB) as preferred initial therapy
• Combinations of drug treatment are usually required to optimise BP control for the majority of patients.
• Thiazide-like diuretics are an alternative to CCB and are preferred for patients intolerant of CCBs, or with heart failure or at high risk of heart failure.
• Beta-blockers are not preferred unless there are specific indications for use, i.e. in patients with symptomatic angina or chronic heart failure.
• For pregnant women or women planning pregnancy, when BP treatment is being considered, the recommendations of the NICE guideline CG107 Hypertension in pregnancy should be followed.

My JBS3risk.com

reposted from: http://www.jbs3risk.com/

crabsallover highlights, key points, comments / links.

Doctors launch new tool to measure your 'heart age' - further advance on QRISK2

reposted from: http://www.nhs.uk/news/2014/03March/Pages/Doctors-launch-new-tool-to-measure-your-heart-age.aspx

crabsallover highlights, key points, comments / links.

QRISK^®-lifetime is the risk engine used at the heart of the new JBS3 calculator. I not sure of the link between JBS3 and QRISK.

“People are being urged to find out their "true" heart age in order to cut the risk of heart attacks and strokes,” BBC News reports. Doctors have put together a new risk calculator called JBS3 that can tell you the real “age” of your heart.

Risk calculators for cardiovascular diseases or CVDs (conditions that affect the heart and blood vessels) are nothing new. The “granddaddy” of risk calculators – the Framingham risk calculator – has been available for years.

But this new JBS3 calculator has the benefits of:

• being easily accessible online
• providing what is thought to be an accurate risk estimate of experiencing a serious CVD such as a heart attack or stroke
• unlike previous risk calculators it is of use to younger adults who, while possibly not having a short-term risk of CVD, could be on the route to a stroke or heart attack due to unhealthy lifestyle choices

This new JBS3 calculator was specifically designed to help healthcare practitioners identify and communicate risk of CVDs to the “sizeable number” of people whose risk in the next 10 years is low, but who may be at high risk over their lifetime.

The calculator includes estimates of someone’s “heart age” and the years they can be expected to enjoy without developing cardiovascular disease.

It also shows the benefits that people would experience if they made changes in their lifestyle such as stopping smoking, or reducing blood pressure or cholesterol levels. It also shows the effects of delaying making these changes.

The ultimate aim of the calculator is to empower people to reduce their risk of cardiovascular disease.

It is expected that the JBS3 calculator will become an important component of the NHS Health Check plan – an ongoing programme for adults aged 40 or over.

Who has produced the risk calculator?

The risk calculator has been produced by experts from 11 UK professional societies (the Joint British Societies or JBS) and charities involved with cardiovascular disease (CVD) prevention.

The tool is based on the available scientific evidence and on assumptions where evidence is not available.

It is part of newly updated JBS guidelines on the prevention of cardiovascular disease, called JBS3.

The guidelines have been written for GPs and practitioners to help guide their work with patients, in preventing CVD.

Why is a new calculator needed?

The JBS notes that although CVD deaths have almost halved in the last 40-50 years, cardiovascular disease is still the leading cause of deaths worldwide. This is especially the case as levels of risk factors for CVD, such as obesity and diabetes, are increasing.

They say that currently, prevention strategies target only those at high short term risk (within the next 10 years) of a heart attack orstroke.

They point out that this ignores many individuals – often younger people and women – who may not be at short term risk, but whose family history and lifestyle factors mean they may be at high risk of developing CVD in their lifetime.

There is a growing body of evidence, they say, that CVD develops over a long term with most heart attacks and strokes occurring in people in the “intermediate risk” category.

The new calculator assesses the risk of heart disease and stroke throughout someone’s lifetime, as well as in the short term.

What sort of people is the risk calculator recommended for?

The JBS recommends that the new calculator is used by healthcare professionals for estimating CVD risk for all individuals except those already known to have CVD or specific conditions that put them at high risk, such as diabetes, chronic kidney disease, or a specific genetic condition that leads to high cholesterol.

One of its main aims is to identify the “sizeable” number of people who are at low short term risk but high lifetime risk, of CVD. It aims to help both patients and health professionals better understand cumulative lifetime risk and what can be done to lower it.

What factors does the risk calculator assess and what results does it give?

The calculator assesses established risk factors for cardiovascular disease such as blood pressure, cholesterol levels, smoking status, family history, age and gender. It uses these to calculate not only the risk of CVD within the next 10 years, but over a lifetime. These are displayed in a number of ways that a healthcare professional can use to discuss these figures with their patient:

• A person’s “Heart age”, compared to someone of the same age, gender and ethnicity with optimal risk factors (for example, not smoking and not overweight or obese).
• “Healthy years” – a thermometer image showing how many years an individual can be expected to survive without having a heart attack or stroke.
• An “Outlook screen” showing a graph with the chance of survival without a CVD event.

The tool also enables the healthcare professional to show the patient the potential effect on CVD risk of various lifestyle changes or interventions such as lowering blood pressure, or stopping smoking.

Can you give an example of the figures the calculator might produce?

The press release accompanying the release of the guideline and calculator gives an example of a 35 year old female smoker, with:

• a high systolic blood pressure (the first number in a blood pressure reading) of 160 mm Hg
• a high total cholesterol of 7mmol/l (the recommended level for healthy individuals is 5mmol/l)
• plus a family history of premature CVD

The calculator estimates that the woman would have a “true heart age” of 47 (above her actual age). She could expect to survive to the age of 71 without having a heart attack/stroke. Her 10 year risk would be less than 2%.

The calculator estimates that if this woman stopped smoking, cut her total cholesterol to 4mmol/l and her systolic blood pressure to 130 mm Hg, her heart age would fall to 30 (below her actual age). She could expect to live to the age of 85 before having a heart attack/stroke and more than halve her 10 year risk to less than 0.25%.

How will the risk calculator be used in the NHS?

The JBS3 risk calculator is going to form a key component of the NHS Health Check programme in England aimed at 40-74 year olds. The authors note it is not intended to prompt blanket prescribing of the cholesterol lowering drugs statins and other heart health drugs.

In a related press release the Joint British Societies are quoted as saying “It is important to emphasise that, for the majority, the strong message will be the potential gains from an early and sustained change to a healthier lifestyle rather than prescription of drugs,”.

Lifestyle changes include quitting smoking, achieving a healthy weight through adopting a healthy diet and boosting the amount of regular exercise while curbing sedentary activity.

Can I use the risk calculator?

The JBS3 risk calculator is openly available online. However it has been designed for use by doctors and other healthcare practitioners with their patients. To work, the calculator requires values you may not have access to yourself (such as your cholesterol levels and blood pressure).

While the calculator can give you a relatively accurate risk assessment it is recommended that the results it provides are also assessed by a health professional.

If you are aged 40 or above you can have a free NHS Health Check which will assess your risk of heart disease as well as other chronic diseases such as dementia, stroke and kidney disease.

The JBS3 risk calculator is not appropriate for people who have existing CVD and should only be used with caution in patients with certain high risk conditions such as high blood pressure, diabetes and chronic kidney disease.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines

Check if your heart is 'older' than you, say doctors. BBC News, March 26 2014

Links to the science

JBS3 Board. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (PDF, 1.7Mb). March 2014

Further reading

The JBS3 Risk Calculator

Why take statins? - British Heart Foundation

reposted from: https://www.bhf.org.uk/heart-health/treatment/statins.aspx

Statins

Statins are the most commonly prescribed medicines in the UK. They work to lower the level of cholesterol in your blood. There are different types of statins, but they all work in much the same way.

Why do I need to lower my cholesterol?

Cholesterol is essential for your body to work well, but too much ‘bad cholesterol’ (called low-density lipoprotein or LDL) is unhealthy. Statins reduce the amount of ‘bad cholesterol’ your body makes.

High levels of ‘bad cholesterol’ in your blood can lead to fatty deposits building up in your arteries. This can increase your risk of developing cardiovascular disease, which includes conditions such ascoronary heart disease  (leading to angina and heart attack) and stroke.

Your body will always make cholesterol so if you stop taking a statin, it’s likely your cholesterol levels will rise. If you are prescribed a statin, you need to take it every day. Statins are most beneficial when you take them on a long-term basis.

Why do I need to take statins? 

If you’ve had a heart attack or stroke, you may be advised to take statins in order to reduce your risk of another event. If you have peripheral arterial disease statins can help to slow the progression. If you are diabetic, you are at a much higher risk of developing cardiovascular disease, and taking statins will help to reduce this risk.

Even if you’re in good health, you may be prescribed statins if you’re at high risk of developing cardiovascular disease, for example, if you have a strong family history of cardiovascular disease. Statins can help lower your risk.

When should I take my statin?

It’s important to take your medication regularly as prescribed. Most statins are taken at night, as this is when most of your cholesterol is produced. Check with your doctor or pharmacist when you should be taking your statin.

Most statins come as tablets. The most common one is simvastatin.
Look up your medication on the Medicine Guides website.

Are there any foods, drinks or other medications I should avoid? 

Check with your doctor or pharmacist before you take any other medications. Taking certain medicines together may affect how well they work.

If you’re taking simvastatin or atorvastatin, avoid grapefruit and grapefruit juice as they can increase your risk of side effects.

If you take another type of statin, limit your intake of grapefruit juice to very small quantities or you may want to avoid it all together.

Do statins have side effects?

Like all medication, statins have potential side effects. The most common are muscular aches and pains, but many people experience none at all. Statins are among the safest and the most studied medications available today.

If you do experience side effects, or if your side effects change or become worse, tell your GP.

Statins target the liver cells where cholesterol is made. Before you start taking statins, you will have a blood test to check how well your liver works. Your doctor may request that you have a follow-up blood test a few months later. If your liver is affected, your doctor may want to reduce your dose or change your statin to another kind of medication that lowers your cholesterol.

Find out about other possible side effects from our Statins information sheet.

Can I buy statins over the counter?

Low-dose statins are available at some pharmacies without a prescription, but they are not a substitute for prescription statins or for making lifestyle changes to reduce your cholesterol level. If you are at high risk of heart disease, your doctor may prescribe a statin for you.

What are the differences between statins?

Lots of people don’t need a strong statin to reduce their cholesterol level. Your GP or cardiologist will find the right statin for you, depending on your medical history and the cholesterol level they think you should aim for.

If you’re sensitive to one statin, you might not be sensitive to another. You should have a blood test after any change of statin to see how effectively the new medicine is lowering your cholesterol.

Can I take a statin if I'm pregnant?

If you’re pregnant, breastfeeding or planning a pregnancy, you should not take statins. If you’re already taking statins but would like to become pregnant, speak to your GP first.

How else can I lower my cholesterol?

You can also lower your cholesterol by:

• eating a healthy, balanced diet
• maintaining a healthy weight, BMI and waist circumference
• doing regular physical activity