High Cholesterol

[L8Again]

My wife has a pacemaker: the result of an investigation into infrequent episodes of syncope. As part of the investigative process she was fitted with a 14 day holter monitor which detected one episode of paroxysmal AF. She was prescribed Edoxaban. On the advice of her cardiologist she also takes peridoprol and lercandipine for hypertension. Her average BP is now down to 118/62 which her cardiologist is very happy with.

A recent cholesterol test came back with a total cholesterol reading of 5.1. A previous cholesterol reading taken a couple of years ago of 5.2 was deemed to be OK by a specialist NHS cardiac nurse. My wife’s GP surgery is now advising statins for a cholesterol reading which in Canada and most of Europe would be deemed normal. In Canada anything below 5.2 is normal and between 5.2 and 6.2 the reading is deemed to be borderline. Readings of >6.2 are deemed to be high.

We suspect that the advice for statins is partly due to my wife’s age; recent heart history (AF and pacemaker) and the associated RiskQ score. All drugs have a downside and given the small deviation from the NICE cholesterol guidelines, the jury in our house is still out as to whether statins are needed. Any thoughts?

[Carercmb]

This past two years cholesterol levels have been reduced to what is considered to be within normal limits.As you get older your family history is also taken into account.

I was very reluctant to go on statins or any medication and have been like that all my life.

After a lot of research and advice from consultants I accepted that the benefits out way any side effects.

I hope this helps.

[Lowerfield_no_more]

You have not told us whether you and your wife are on board with 'lifestyle' measures to reduce the cholesterol levels given your wife is borderline by current recommendations, although it is usual for people with known heart conditions to aim lower. Diet can certainly impact cholesterol levels and exercise and alcohol consumption and no smoking may also impact it too. However dependant upon where you start from the overall change is not as noticeable as taking statins and lifestyle is only as good as what you do and how long you do it. My suggestion is to give a low dose statin a trial and see what happens, noting that in spite of the naysayers side effects only affect < 10% of users and the benefits are usually reckoned to outweigh the risk, and any improvement on a lipid profile is better than none.

[L8Again in reply to Lowerfield_no_more]

I am on Rosuvastatin so there is no issue in our house over statin use per se. I recall being told many years ago that with a family history of high cholesterol, I could live on just lettuce leaves and it wouldn’t result in a measurable drop in my cholesterol.

As my wife has asymptomatic paroxysmal AF, she is already at a higher risk of stroke than someone who hasn’t got AF: hence, the use of Edoxaban.

Recent clinical research into the use of statins and BP meds has revealed some unexpected results. In the majority of people, the drugs play happily together: however, within the tested cohort there was evidence of the mix resulting in a reduction in the effect of the hypertensive drugs, and in some cases statin use resulted in the BP drugs having a multiplied effect.

Given that the cholesterol increase is only marginally above the UK normal level; less than the norm for most European countries and Canada and - a reduction from 5.5 the previous year (which attracted no GP comment) - my wife is cautious about adding another drug into her daily cocktail. FWiW, a GP ( yes they still exist) did say a year or so ago that using present risk metrics all people over 80 would fall into the ‘ should have statins’ category because of the age-related increase in stroke risk irrespective of their cholesterol level.

[Tkay04]

coincidentally, I have a pacemaker for the same condition. Personally I have a AF burden 0.1% so less than 10 hours per year but prescribed 2.5mg Bisoprolol, Apixaban and as can be seen from my cholesterol test in October last year of 5.2 I was also prescribed 20mg Atorvastin once per day.

I’m not an expert but made a decision to halve my dose which has lowered my cholesterol into the normal level.

I am yet to have a detailed discussion with my EP about taking the continued medication of both the blood thinner or statin if my risk is very low.

Cholesterol results

[Silvermedal]

Last year I was also told my cholesterol should be below 4. I queried this as the NICE guidelines say 5. I was told that new research suggests below 4 for people with heart conditions, but this is yet to be incorporated in the NIce guidelines.

I checked today and found this

Lipid target for people taking lipid-lowering treatments

1.7.1

For secondary prevention of CVD, aim for low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less. [December 2023]

The guidelines were revised last December and can be found by googling "nice cholesterol"

Cardiovascular disease: risk assessment and reduction, including lipid modification

NICE guideline [NG238]

You may find section 5.1 Discussions before starting statins useful.

[L8Again]

I think that we have the advice that we need. Two major studies (Europe and the USA/Canada) released last year have shown that whilst statins have no direct impact on AF in the elderly, there is clear evidence that the prolonged taking of statins can significantly reduce the possibly of strokes - irrespective of whether or not the patient takes an anticoagulant.

Research has shown that taking statins for 6 years can reduce the risk of some types of AF-related strokes by 43%. The recommendation seems to be that physicians should consider prescribing statins for all newly diagnosed AF patients along with an anticoagulant.

[sandandkev]

I've found that since my heart probs they like bad cholesterol to be under 2.5!! Mine is 5.1 which is why now trying statins but am on 3rd lot as won't tolerate side effects as life just too short