Are statins for you? Being thin doesn’t necessarily mean you’re healthy
I’m 39, I eat healthily and I’m slim, but a routine blood test last year showed I had high cholesterol and a test last week showed my levels are getting higher. Do I need statins?
Lilian Aoun, by email
Clearly you’re concerned about cholesterol building up in your arteries, which could lead, eventually, to a heart attack or a stroke.
Statins are prescribed for one of two reasons: to reduce the risk of an event such as a stroke in someone who’s otherwise healthy but has risk factors for cardiovascular disease, such as raised cholesterol (this is known as primary prevention); and to lessen the risk in patients who have already been diagnosed with arterial disease, usually after an episode such as angina (chest pain) or a heart attack (this is known as secondary prevention).
You have enclosed a copy of your blood test results and I can see that most of the measurements — fasting blood sugar levels, kidney function and liver function — are normal and, therefore, reassuring about the state of your overall health.
What is of concern is your level of ‘bad’ low density lipoprotein (LDL) cholesterol, which is 4.9. The accepted normal range is up to 3.
This is the type of cholesterol that is known to be a risk factor for atherosclerosis (furring-up of the arteries), which can lead to a heart attack or stroke.
However, levels of cholesterol alone tell us almost zero about the risk of heart disease because these levels can be affected by so many factors, such as how much fat from your diet is absorbed into your bloodstream from your intestine, or the way LDL is manufactured in your liver.
All too often, an assessment is made on the basis of just one measure, such as high cholesterol, and this is a mistake.
To determine your risk — and, as a result, whether you need medication — you need to see your GP or a cardiologist to undergo a Qrisk2 assessment. This is a questionnaire that takes into account all the risk factors and comes up with a score for the likelihood of developing heart disease or having a heart attack or stroke in the next ten years.
Risk factors include someone’s age, sex, body mass index, ethnicity, their family history of heart disease and whether they have diseases such as diabetes, high blood pressure and kidney disease, as well as their cholesterol levels.
If the score is above 10 per cent, NHS guidelines recommend treatment with a statin — in particular atorvastatin at 20mg each day — taken long term.
Your doctor should also discuss the benefits of lifestyle changes, such as taking regular exercise and being extra careful about salt intake to lower your blood pressure, as this is a major risk factor for a heart attack.
It is possible that significant lifestyle changes might result in a lower Qrisk2 score.
My own LDL level is 3.2, and with low blood pressure and a low body mass index of 17.9, my Qrisk2 score still indicates a 12.66 per cent chance of having heart disease or a stroke in the next ten years. But the difference between you and me is age — a major risk factor that cannot be changed.
Talk to your GP to discover your Qrisk2 score, listen carefully to the lifestyle changes that are recommended and be ready to make a commitment to lowering your cholesterol level.
Whether statins are appropriate for you must be left to individual preference (that is, yours and the doctor’s) as there is no one-choice-fits-all when it comes to primary prevention.
I have had a bout of shingles lasting five weeks, despite the fact I had a shingles jab last November. Why did this happen? And should I avoid the sun in case it activates the virus again?
Marianne Brookes, Wellingborough, Northants.
I’m pleased to hear you’ve had the immunisation against shingles — Zostavax — even though you were unlucky and it failed to prevent an attack.
Shingles, or herpes zoster, is an infection caused when the varicella zoster virus is reactivated. Most of us contract this virus as a child in the form of chickenpox, and once this has cleared up, the virus lies dormant in our bodies.
But if your immune system is then compromised in any way — for instance, if you’re being treated with steroids or cancer drugs, or even simply due to ageing — the virus can escape and travel down a nerve to reach the skin, producing the painful blistering rash of shingles.
Shingles, or herpes zoster, is an infection caused when the varicella zoster virus is reactivateD
Some patients experience excruciating nerve pain for months or years.
I have argued repeatedly on this page for everyone over the age of 50 to receive Zostavax. More than 20 per cent of this age group will suffer from shingles, but on the NHS the vaccine is available only to certain age groups over 70.
The immunisation works by introducing a modified ‘locked-up’ virus into the body to encourage the immune system to make anti-viral antibodies to prevent the virus becoming reactivated.
Zostavax is not guaranteed to prevent such an attack and fails in about 40 per cent of recipients, possibly because the antibody levels are still not high enough to prevent the virus reactivating.
But if you have the vaccine and it does fail, shingle attacks are much less severe, they resolve faster and complications such as nerve pain, which often persists after the attack, are unlikely.
Also, now you will have an even higher level of immunity to the virus as your system has been primed twice to attack it.
There is no need for you to avoid sun exposure, a known trigger for shingles, as I think you are safe. Nevertheless, you should be aware of known concerns over sun and its potential for significant damage to skin — the greatest fear is skin cancer, so do be cautious.