How do statins work?

PerSpinasAdAstra said:
I won't argue with your doctor. All I'll say on this is that the judgement call on the part of your doctor will take your age into account. For me, at 46 years of age, male, was obese for quite a while, ex-smoker of 20 years, with metabolic syndrome and a T2 diagnosis I may be quite some way along the path to heart disease already, and I have a long way to go before I reach your age. That's a lot of years where lower cholesterol levels might help me avoid a heart attack at some point down the line. On the day I was diagnosed the QRisk3 calculator put my odds of having a heart attack or stroke at higher than 50% in the next 10 years. That's extremely high for a 46 year old, as you can imagine. My GP advised a statin, and my diabetologist was keen that I aim for a very low cholesterol target (though I argued back at the time, because I didn't understand why). For me, with much damage done and far to go, a statin is an extremely good idea. If your cholesterol levels are now normal, and you've brought your HbA1c down, your doctor may not believe a statin is necessary to curb your heart disease risk for the remainder of your journey. Statins have their greatest effect over a span of decades.
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That all makes sense. Thank you.
 
PerSpinasAdAstra said:
On the day I was diagnosed the QRisk3 calculator put my odds of having a heart attack or stroke at higher than 50% in the next 10 years.
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Eek! My consultant was getting pretty twitchy about statins when my Qrisk was tickling over 10% 😱
 
i am on 80 mg of Atorvastatin a day and was on 10 mg of Ezimbe which now they took off me , its quite a hefy dose my blood pressure went high and i am on Candesartan 16 mg a day and Amlodipine 5 mg a day , its a lot of drug to take and i wonder is the right plan , it worries me tbh
 
My Qrisk was 5.2, I decided to take the diet approach.
If I added in the ckd my score went up to 7.7 but I have an objection to that on the basis that the only kidney related question is do you have ckd stage 3, 4 or 5.
Clearly the risk at stage 3a and the risk at stage 5 cannot be identical. If they had asked my eFGR then I could accept the elevated risk, but nope, rejecting that at this time.

Since losing weight my Qrisk (excluding ckd) is 4.3, which is identical to a healthy person (but 6.4 if I factor in the non-specified level of ckd).
I'm still awaiting the results of my cholesterol test I had on Friday. I wasn't going to try phone on a monday (such torture), but will probably phone them tomorrow.
 
s'nic said:
I'm still awaiting the results of my cholesterol test I had on Friday. I wasn't going to try phone on a monday (such torture), but will probably phone them tomorrow.
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Do you have the NHS app?
My results are published for me on the app so I have no need to phone the GP to get them.
 
s'nic said:
My Qrisk was 5.2, I decided to take the diet approach.
If I added in the ckd my score went up to 7.7 but I have an objection to that on the basis that the only kidney related question is do you have ckd stage 3, 4 or 5.
Clearly the risk at stage 3a and the risk at stage 5 cannot be identical. If they had asked my eFGR then I could accept the elevated risk, but nope, rejecting that at this time.

Since losing weight my Qrisk (excluding ckd) is 4.3, which is identical to a healthy person (but 6.4 if I factor in the non-specified level of ckd).
I'm still awaiting the results of my cholesterol test I had on Friday. I wasn't going to try phone on a monday (such torture), but will probably phone them tomorrow.
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QRisk 3 is a blunt instrument alright, though I suppose they'd need a huge amount of data to improve it.

Example: Diabetes - None, Type 1 or Type 2. No accounting for HbA1c, time since diagnosis or anything like that. As a result there are some who don't trust it, believe that being in remission means they are free of increased risk of heart disease (despite insulin resistance being a risk factor, despite having spent years progressing from healthy glucose levels all the way to a T2 diagnosis) and believe that their doctor is engaged in a box-ticking exercise by suggesting a statin. It's a problem, though on the diabetes question alone they'd need a massive amount of data to make the calculator better and it would be more complex to use.

Smoker: For me, I'm 'ex-smoker'. There's a world of difference between a person who smoked 10 a week for a couple of years and a person who smoked 20 a day for 20 years. The calculator treats both scenarios the same. Far from ideal, but it is what it is I suppose.
 
helli said:
Do you have the NHS app?
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I tried registering for that but I hit problems (I'm in wales), I haven't taken time to pursue that again yet.
I can see my surgery on the nhs wales site, but my surgery are severely lacking on the detail they add.

@PerSpinasAdAstra exactly!
I accept that my risk will be elevated, I just can't see their figure based on ticking a generic ckd box as accurate. I'd also like to see a box I could tick for prediabetic as well.
There's no diastolic BP (systolic could be normal, but a low diastolic could place you in a 'low bp' group)
Lets not even go there on cholesterol ... my ratio was pretty good, which of course is what that page asks for. But my cholesterol and triglycerides were both high, and the qrisk tool totally misses that.

Yup, a very blunt tool 🙄
 
s'nic said:
I tried registering for that but I hit problems (I'm in wales), I haven't taken time to pursue that again yet.
I can see my surgery on the nhs wales site, but my surgery are severely lacking on the detail they add.

@PerSpinasAdAstra exactly!
I accept that my risk will be elevated, I just can't see their figure based on ticking a generic ckd box as accurate. I'd also like to see a box I could tick for prediabetic as well.
There's no diastolic BP (systolic could be normal, but a low diastolic could place you in a 'low bp' group)
Lets not even go there on cholesterol ... my ratio was pretty good, which of course is what that page asks for. But my cholesterol and triglycerides were both high, and the qrisk tool totally misses that.

Yup, a very blunt tool 🙄
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The new US risk calculator is more nuanced: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

Better focus on the "cardio-renal" profile: considers both eFGR and (optionally) uACR. Considers HbA1c level. For younger folk produces a 30 year assessment, more useful than just10 years except for people who don't intend living longer than 10 years 🙂. Stratifies by baseline non-HDL-C, not the discredited total chol/HDL ratio used by QRISK.

Units are in American, of course, but easy enough to convert. Obviously referenced to a different population compared to the UK, which presumably limits usefulness to some extent.

If you know your CAC, there's another useful professional calculator which adds that into the mix: https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator
 
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s'nic said:
lol, I just looked at that link .. this post ... she should realise that viruses change and mutate :confused:
View attachment 31074
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Gosh, she hasn't even got a basic understanding that 'things change'? Like most 3 year olds can grasp that concept!
 
helli said:
I don't have insulin resistance so not sure why you are sharing this.
(I also don't learn by watching videos.)
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I never said you had insulin resistance.

Also, there are others besides yourself using this public forum.

Regarding how you learn, this has no relevance to the forum or others who benefit from it.
 
Eddy Edson said:
The new US risk calculator is more nuanced: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

Better focus on the "cardio-renal" profile: considers both eFGR and (optionally) uACR. Considers HbA1c level. For younger folk produces a 30 year assessment, more useful than just10 years except for people who don't intend living longer than 10 years 🙂. Stratifies by baseline non-HDL-C, not the discredited total chol/HDL ratio used by QRISK.

Units are in American, of course, but easy enough to convert. Obviously referenced to a different population compared to the UK, which presumably limits usefulness to some extent.

If you know your CAC, there's another useful professional calculator which adds that into the mix: https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator
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Many thanks, I have bookmarked these so I can try them once I pick up the printout of my blood test
 
helli said:
My question was to learn how and when best to take them and what to do if I forget. But with knowledge on how they work rather than being told "take one tablet with your evening meal
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During a recent hospital stay, the pharmacist was surprised that I take my statin tablet with everything else in the morning. I found that I often forgot to take the tablet in the evening. I asked if it mattered. She said it was better to take it in the evening, but the most important things was to take it, so if by doing it in the morning I remembered that was fine.
 
SB2015 said:
During a recent hospital stay, the pharmacist was surprised that I take my statin tablet with everything else in the morning. I found that I often forgot to take the tablet in the evening. I asked if it mattered. She said it was better to take it in the evening, but the most important things was to take it, so if by doing it in the morning I remembered that was fine.
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That is what I understood from BHF.
The liver produces more cholesterol over night so, if you take your statins at night, it should have more affect. However, the difference is not that great and better to take it rather than worrying about time of day.
 
SB2015 said:
During a recent hospital stay, the pharmacist was surprised that I take my statin tablet with everything else in the morning. I found that I often forgot to take the tablet in the evening. I asked if it mattered. She said it was better to take it in the evening, but the most important things was to take it, so if by doing it in the morning I remembered that was fine.
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Was only on statin matter of months but was told to take it before bed not in a morning.
 
helli said:
That is what I understood from BHF.
The liver produces more cholesterol over night so, if you take your statins at night, it should have more affect. However, the difference is not that great and better to take it rather than worrying about time of day.
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Helli agree and if you are taking a shorter acting statin it makes more sense to take it an night to counteract the liver producing cholesterol overnight whereas if you take a longer acting statin it makes no difference as to whether you take it morning or evening
 
Wendal said:
Helli agree and if you are taking a shorter acting statin it makes more sense to take it an night to counteract the liver producing cholesterol overnight whereas if you take a longer acting statin it makes no difference as to whether you take it morning or evening
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How do you know if you are taking "longer acting" or "shorter acting" statins?
There is no hint on my packaging about how fast acting mine are.
 
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