Website last updated 29/06/2025
Cholesterol
- Less than 50% of patients adhere to statin treatment after 1 year
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- Weight and cholesterol are closely related. Losing weight generally reduces cholesterol​​
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- Patient's on statins or other cholesterol lowering therapy should have their cholesterol levels checked yearly once stable
- LDL cholesterol tends to increase with age
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- Patient's should be suspected of familial hypercholestrolaemia if:
- their total cholesterol level is above 7.5mmol/l and/or
- Premature CHD (onset <60 yrs) in patient or first-degree relative
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- Patients suspected of FH should be referred to a lipid clinic
Atorvastatin 20mg should be considered when the patient does not have CVD and falls under the following:
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- Atorvastatin 80mg should be offered to all patients who have CVD. If the patient's eGFR is below 60 then start on 20mg.
- Before starting statins for primary prevention, ensure the patient has recent LFTs, U&Es, and non-fasting lipids. If not, these tests should be repeated before treatment begins.
- TFTs should also be checked as hypothyroidism can increase cholesterol levels
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- For secondary prevention, this is not usually needed as it is commenced in secondary care
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- LFTs and NF lipids should be repeated 2-3 months after starting statins or increasing the dose of any current statin
- This is the most common side effect of statin therapy
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- Statin induced myopathy usually presents as:
- symmetric burning or pain in the large muscles during exercise that was not present before lipid-lowering therapy
- disappears within 2 weeks of discontinuing therapy
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- If statin induced myopathy is suspected:
- check the patient's creatinine kinase levels
- Reduce the dose of the statin if possible
- Consider switching to a different statin
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- If CK is more than 5 times the upper limit of normal, re-check after 7 days. If the level is still 5 times the upper limit of normal, do not start statin treatment.
- For primary prevention, aim for a 40% reduction in non-HDL levels from the baseline non-HDL
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- If this is not achieve after 2-3 months:
- increase the dose and repeat LFTs and NF lipids in 2-3 months
- Continue doing this until the target non-HDL levels are achieved (considering side effects and adherence)
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- Once target levels are achieved continue the statin at that dose and check LFTs and NF lipids annually
- When switching statins, for example due to side effects, aim to switch to a dose that has the same efficacy.
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- For example when switching from atorvastatin 20mg to rosuvastatin, a dose of 10mg would be sufficient.
- Higher doses can be considered if non-HDL target not achieved.
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- This medication can be considered when:
- Patients are having side effects from multiple different statins
- Patient's refuse to take statins
- Statins are not suitable for the patient
- This can be used either:
- As monotherapy if statins not tolerated/ suitable
- In combination with a statin if lower doses of statin are tolerated but cholesterol levels not in target
- Advise patient to book call the surgery or 111 if having muscle related symptoms
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- Risk of interstitial lung disease: If patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.
- Contraception is required during treatment and for 1 month afterwards.
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- Advise on symptoms of heart attack and stroke and to call 999
Why are some patient's so reluctant to start statins?
The controversy in the United Kingdom started in 2013 when the British Medical Journal (BMJ) claimed statins were being overprescribed to people with low risk of heart disease, and that the drugs’ side effects were worse than previously thought