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Leading the way in patient care......

Ash Surgery

Chilton Place
Telephone: 01304 812227
Fax: 01304 813788

In a seperate article on website, we have discussed cholesterol testing and Cardiovascular risk. In that article it was expained that it was not the cholesterol itself, but the patients overall CV risk which was being assessed. In this article I will consider management of raised Cholesterol (raised CV risk).

Please remember, this discussion relates to people with no previous known CV history (eg past angina, heart attack, stroke, TIAs, diabetes) as this group would automatically be strongly advised to start statin medication.

  • Diet

For those people who are identified, through a cholesterol result, to be at increased CV risk we are advised by NICE guidelines to consider treatment with a statin if that risk is >10% in the next 10 years. Clearly, before we leap into “medication mode” it is sensible to check that there is no underlying dietary reason. So it is usually advised that the person try a low cholesterol diet, and then repeat their cholesterol after a few months.

For further information on low cholesterol diets, Heart UK have a very useful diet sheet which we refer to in the surgery. This is available on

or making an appointment with the Practice Nurse who has leaflets to distribute.

However, it is important to note that your cholesterol level is a result of many factors, not just your diet. I see many people who have perfect diets, but poor cholesterols (and vice versa). This is because of a very large genetic effect.

  • Medication (statins)

Following the dietary trial, if the cholesterol level remains unchanged (hence the CV risk continues >10%), the next step is likely to be consideration of medication. The medicines that are used are called statins, the most common ones are Simvastatin and Atorvastatin and there are others.

Statins act in the liver, where they block a particular enzyme which is needed to make cholesterol. Hence, blood tests need to be checked before and some time after starting statins to check both the cholesterol and liver tests.

Most people do not have side effects from statins, and benefit from their action in reducing cholesterol. However, minor side effects can occur, mostly gastro intestinal in type. Some people complain of significant joint pains and aching when taking statins. This is a difficult side effect to interpret- given that we all can get aches and pains from time to time. My usual advice if this happens, is to stop the statin for a few weeks, and then restart it. Obviously, if the aches/ pains recur on restarting.. then the medication is not suiting you well. It is still worth going back to your GP at this point and seeing if using one of the other statins would work for you.

Some patients, usually those who have had a past heart attack/ stroke/ or similar, are prescribed very high doses of statins. In this group there has been shown to be a very slight increase incidence in development of diabetes in those taking statins. This fact might rather put one off using a statin… but the risk is very low (about 1 in 500 in this group). However, the benefit of the statin has been shown to outweigh the 1 in 500 risk of diabetes—in that about 1 heart attack or stroke is avoided for every (approximately) 150 patients on a statin. Like all things in medicine there is no “no risk” option- it is always a question of looking for the best path, not necessarily the perfect path.

There are other medicines that can be used if statin do not work, or are not tolerated. But their evidence base is not nearly as strong as for statins, so they are prescribed far less commonly

  • Lifestyle Measures

And finally - It is about reducing total CV risk. So, whether or not you are tolerating and taking the statin, it is vital to look at the other aspects.

  • Regular exercise is known to improve general feeling of wellbeing and will reduce CV risk.
  • If you are overweight (BMI >30), then a calorie controlled diet is worth looking into.
  • If you smoke, stopping would be likely to reduce your CV risk much more than controlling your cholesterol.
  • Doing both would be even better!
  • If you have not had your blood pressure checked—then book with our nurse to do so. If it is raised, then good control will reduce your risk.
  • If your BMI is raised and/ or if there is a family history of diabetes, then getting your blood sugar checked to rule out diabetes is important.


The NHS runs a system of Health Checks for those from the ages of 40-74years. Those people in this age group can expect to be called for a health check every 5 years. At this check, markers such as height, weight, BMI, BP, cholesterol, and more will be checked. At Ash Surgery this is done by Doreen in the surgery.

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