I have been on statins for over 30 years. I’m on my fourth type now, as each is causing me bad side effects. How important is it that I take them?
Name and address provided.
This question will be of interest to many of the eight million people in the UK who take statins to lower their cholesterol.
Cholesterol, a natural fatty substance in your blood, is important for the functioning of many processes in the body (for example, it is used by skin cells to make vitamin D from sunlight). However, high levels increase the risk of heart disease and stroke by contributing to fatty deposits in artery walls.
Despite the benefit of statins, as many as one in two people reduce their dose or stop taking them because of the side effects, such as muscle pain and constipation.
I have been on statins for over 30 years. I’m on my fourth type now, as each is causing me bad side effects. How important is it that I take them? (stock image)
The fact that you eat a healthy diet is helpful, but it is unlikely to lower your cholesterol enough (stock image)
However, a study of four million patients published in the European Heart Journal last year suggested that the true prevalence of side effects is probably closer to 10 percent. For example, other research suggests that muscle soreness is a result of aging rather than the medication.
It’s hard for me to advise whether statins are essential for you without knowing all of your risk factors for heart disease (such as, say, age, ethnicity, blood pressure, and family history). You say in your longer letter that your cholesterol is 7 mmol/L, which is above the recommended limit of 5, and you are also pre-diabetic.
The fact that you eat a healthy diet is helpful, but it is unlikely to lower your cholesterol enough. That’s because most cholesterol is made in the liver, and a host of factors, including genes, determine how much the body makes.
There are other drugs that lower cholesterol. One possible option for you is the drug ezetimibe, which can be prescribed alone or in combination with a statin. While statins work by suppressing cholesterol production in the liver, ezetimibe decreases the absorption of cholesterol in the gut. But it also has possible side effects, such as abdominal pain.
Another option is a new class of drugs called PCSK9 inhibitors. These work by inhibiting a protein (PCSK9) in the liver that breaks down receptors to which the ‘bad’ LDL cholesterol attaches. The more of these receptors you have, the lower your LDL.
The two currently available PCSK9 inhibitors are only prescribed for patients who cannot take a statin or cannot control their cholesterol with ezetimibe. They’re given by injection every two to four weeks, but they too have potential side effects: 1-10 percent of patients experience flu-like symptoms for a day or two after the shot.
PCSK9 inhibitors must be prescribed by a cardiologist or in a vet treatment clinic, so you will need to get a referral through your GP. But keep on finding a treatment that works for you, as the health benefits of lower cholesterol can be significant.
My dad has pain in his toes when it’s cold, and they can be purple, swollen, and painful to the touch. What do you think the problem is?
Hayden Wan, Glasgow.
I believe your father has chilblains, a complaint that affects 10 percent of people at some point.
They are activated by exposure to cold or moist air: as the skin warms up, small, itchy, red or purple swellings can form. These swellings can be painful and blistering.
They occur when the small arteries near the surface of the skin become narrow when it is cold; they then enlarge as the heat returns, but in some people the blood vessels cannot handle the increased blood flow if the skin warms up too quickly. The blood leaks into nearby tissue, causing the symptoms associated with chilblains.
Although the toes are the most common site, in fact all extremities of the body – fingers, heels, ears, nose – can be affected.
Chilblains can last for months, especially in the UK, thanks to our damp, cold weather. While they normally disappear at this time of year, they can persist throughout the summer as any sudden cooling or heating can activate them. Even walking barefoot on cold floors can be a trigger, so I recommend wearing socks and warm slippers at home.
Smoking and vaping significantly increase the risk because they constrict blood vessels, so if your dad is a tobacco user, quitting will help.
Soothing witch hazel lotions can help with itching, but it may be worth asking your GP about the drug nifedipine. When taken daily, it works by relaxing blood vessels and improving circulation. But it does carry a risk of side effects such as dizziness (because it lowers blood pressure), so I would urge your father to focus on prevention.
- Write to dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.
I think: Raising the bar for fellow doctors
Every now and then I hear something that confirms my confidence in my profession.
The patient was seen by a cardiologist the next day and full investigations are ongoing (stock image)
Last Saturday, an old friend returned from a concert with his wife on a dark, rainy night. As they walked back to their car, his wife – still out of breath – said she couldn’t go on and needed to rest. Their doctor came the other way.
He sat her down on a nearby bench, did a brief examination (in the dark and in the rain) and advised her to see a cardiologist, saying he would arrange it.
On Monday, he visited her at home and spent an hour doing a physical examination. The patient was seen by a cardiologist the next day and a full investigation is ongoing.
It’s a shame it happened in Toulouse, France, where the couple recently retired. Nevertheless, this is the kind of standard of care we should strive for.