Do I really need statins? DR MARTIN SCURR answers your health questions
I am a fit, healthy, slim female in my 70s who exercises and eats a healthy diet, but my cholesterol is in the 6s. My old doctor used to tell me not to worry because although my HDL cholesterol was very high, my LDL was very low. I have recently been prescribed statins by my new doctor, but they are giving me very bad dreams. Do I really need statins?
Judith Eyre, via email.
It’s marvellous that you’re exercising and eating well — key foundations to looking after your cardiovascular health.
The question of whether you really need statins is down to your risk of atheroma — the accumulation of fatty cholesterol-containing deposits in the arteries, particularly those supplying the heart and brain with blood.
Atheroma can lead to a heart attack or stroke, both caused when the arteries feeding these areas are blocked by fatty deposits or a blood clot.
High cholesterol levels are one of the key risk factors for atheroma. Ideally, your total cholesterol should be below 5 millimoles per litre (mmol/L), with HDL (or ‘good’) cholesterol 1 mmol/L or above, and LDL (‘bad’) cholesterol 3 mmol/L or below, according to the NHS. On these measures your readings are slightly higher than advisable.
Atheroma can lead to a heart attack or stroke, both caused when the arteries feeding these areas are blocked by fatty deposits or a blood clot
Lowering LDL cholesterol by 1 mmol/L with a daily statin can significantly lower the risk of heart problems if you’re someone who’s been identified as at risk.
However, it’s also worth looking at the other areas of heart-related risk that can be modified, too — all of which are assessed by an online tool doctors use called the Qrisk profile. This is a cardiovascular disease risk calculator where the main factors are age, sex, ethnicity and postcode as well as other established health data (such as smoking, diabetes and family history).
Whether you need statins depends upon your score. If your chance of a significant health event is greater than ten per cent in the next ten years then it’s worth doing everything possible to cut your risk.
So although you’re not overweight, don’t have high blood pressure and exercise regularly, other issues such as your past medical history and family history may increase your risk profile and your current GP may consider statins a necessary additional measure of protection.
It’s just as possible that your previous GP was not using the calculator and was reassured because of the favourable balance between HDL and the more damaging form, LDL cholesterol, in your case.
But it’s worth asking your GP for a different statin that may not affect your sleep.
I sometimes burp excess-ively after eating or drinking and develop an ache at the top of my belly, which can last for eight hours. Over-the-counter indigestion tablets don’t help with the pain. What can I do?
Stephen Darch, Gloucester.
The combination of burping and pain you describe suggests one of two conditions — gallstones or a peptic ulcer.
Gallstones are small stones that form in the gallbladder and can lead to flatulent dyspepsia — the pain and belching you describe.
The gallbladder, a small pear-shaped organ in the upper abdomen, stores bile, produced by the liver. After we eat the gallbladder contracts, releasing bile into the stomach to help digest fats.
If a gallstone becomes lodged, the gallbladder continues to contract, but as bile can’t move past the stone it can lead to pain.
The other possibility is that it’s a peptic ulcer — essentially a raw area — on the lining of either the stomach or in the small intestine.
Your GP will be able to confirm which it is by referring you for an ultrasound scan — this will show if there are any gallstones.
You might also be offered a barium meal X-ray (where you swallow a liquid that shows up on an X-ray) to check for ulcers — or an endoscopy, where a long thin camera is inserted via the mouth down the oesophagus. If you have an ulcer, you’ll need further tests for the bacterium Helicobacter pylori, which causes most ulcers. If you test positive, you will be given antibiotics to clear it and allow the ulcer to heal.
Indigestion — caused by powerful digestive acid in the stomach spilling up into the oesophagus — is known to further irritate ulcers, so it is worth exploring stronger medications for preventing this with your GP.
If the diagnosis is gallstones then the only treatment option long-term is surgery to remove the gallbladder.
Losing the gallbladder will not affect your quality of life.
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