Why am I being offered cholesterol lowering medication?

Did your GP or nurse at Leylands recently suggest starting medication to reduce your risk of heart disease and strokes?

Did you receive an SMS from us offering to start treatment? If you’re wondering how to respond, we’ve prepared some information for you, so read on and hopefully your questions will be answered.

The article below is a five minute read but if you’re pressed for time, here’s the super quick 30 second summary:

We’re offering you cholesterol-lowering medication to reduce your risk of cardiovascular disease, including heart attacks and strokes. Your risk score is based on multiple factors, not just cholesterol. If your score is 10% or higher, medication is recommended—statins are the first choice as they effectively lower cholesterol and reduce heart disease risk. We’ve made it easy—no need for an appointment, simply reply to the SMS to get started. Most patients in your situation choose this treatment to stay healthier and reduce future risks. If you’ve tried statins before and couldn’t tolerate them, don’t worry – alternative treatments are now available to help lower your cholesterol and protect your heart. Read on below for more information….

Understanding your cardiovascular health

Your cardiovascular system (the heart and blood vessels) is one of the most vital organ systems in your body, and maintaining its health is crucial for living a long and healthy life.

Cardiovascular disease is the leading cause of death world wide.

Taking control of your heart health

Trying to make positive lifestyle changes is one of the most important things you can do to help reduce your risk. One thing I often say to my patients is that if exercise was a tablet, it would be the most beneficial and effective preventative treatment we ever had.

Take a look at this brilliant video which explains how beneficial exercise is.

Does the word ‘exercise’ worry you? Please don’t be afraid – exercise does NOT necessarily mean running a marathon or going to the gym. Exercise is different for each person. For some people it might just mean a brisk walk, or simply doing sit to stands from a chair. Anything you can do to increase your level of activity, no matter how small, will have benefits.

The most important lifestyle changes to focus on include:

Eating a heart-healthy diet: Focus on vegetables, whole grains, lean proteins and fruit. Do note however that some fruits can be high in sugar (e.g. grapes, ripe bananna, mango) so if you have diabetes for example, always eat these after a healthy meal, and in moderation.
Exercising regularly: Aim for at least 150 minutes of moderate exercise each week.
Try to maintain a healthy weight: Of course healthy eating and regular exercise are the main ways to achieve this – but bear in mind to lose weight, the focus will primarily need to be on diet.
Quitting smoking: Smoking significantly increases your risk of heart disease and quitting is the single best thing you can do for your health.
Managing stress: Chronic stress can contribute to heart problems.

What is your cardiovascular risk score?

One of the ways we assess your heart health is by looking at your cardiovascular risk score, which helps predict your risk of having a heart attack or stroke in the next 10 years. If your cardiovascular risk score is 10% or higher, this means you have a significant (one in ten) risk, and taking steps to reduce this risk is important.

QRISK2 is a tool used by healthcare professionals to estimate your cardiovascular risk. It considers several factors, including:

Age
Gender
Ethnicity
Blood pressure
Cholesterol levels
Smoking status
Family history of heart disease
Other health conditions like diabetes

Even if your cholesterol levels are within a normal range, other factors might still place you at a higher risk. This is why your cardiovascular risk score might be raised even if your cholesterol level is not very high.

If your risk score is 10% or higher, we may offer you medication.

Why cholesterol matters

Cholesterol is a fatty substance in your blood. While your body needs some cholesterol to function properly, too much can lead to a build-up in your arteries, which increases your risk of heart disease and stroke. Cholesterol-lowering medications, known as statins, help reduce the amount of cholesterol in your blood, which can help lower your risk of heart problems.

But it’s about more than just cholesterol

If you check your results online, you’ll see there’s more to it than just your cholesterol level. Here’s a simple explanation of what those numbers mean:

Total Cholesterol: This is the overall amount of cholesterol in your blood. Cholesterol is a fatty substance that your body needs, but too much can lead to health problems.

Low-Density Lipoprotein (LDL) – “Bad” Cholesterol: If there’s too much LDL cholesterol, it can build up in your arteries, making them narrow and increasing the risk of heart disease and stroke. Lower levels of LDL are better for your health.

High-Density Lipoprotein (HDL) – “Good” Cholesterol: HDL helps remove excess cholesterol from your arteries and takes it back to the liver, where it’s broken down and removed from the body. Higher levels of HDL are good because they help protect against heart disease.

Non-HDL Cholesterol: This is your total cholesterol minus your HDL cholesterol. It includes all the “bad” types of cholesterol, like LDL. Keeping non-HDL cholesterol low is important for reducing heart disease risk.

Cholesterol to HDL Ratio: This is your total cholesterol divided by your HDL cholesterol. A lower number means a lower risk of heart problems.

Triglycerides: Triglycerides are another type of fat found in your blood. High levels can increase your risk of heart disease. Factors like diabetes, being overweight, eating a lot of sugary foods, drinking too much alcohol, and not being active can raise triglyceride levels.

The take home message: Lower levels of LDL and triglycerides, along with higher levels of HDL, are generally better for your heart.

For more detailed information, you can visit these resources:

HEART UK: Understanding Your Cholesterol Test Results
Patient.info: Understanding Your Cholesterol Levels

Why you’re being offered medication

There are several scenarios where you might be offered cholesterol-lowering medication:

Very high cholesterol levels, regardless of your risk score: If your cholesterol level is very high above 7.5 mmol/L, even if your cardiovascular risk score is not 10% or more, in some situations, we might offer cholesterol lowering medication. Especially if you have a strong family history of cardiovascular disease. This is because in these situations, the cardiovascular score can underestimate your risk.
Raised cardiovascular risk score: Even if your cholesterol level doesn’t seem particularly high, cholesterol is just one piece of the jigsaw that makes up your cardiovascular risk. Your overall QRISK2 score might still be 10% or higher due to other factors. In this case, you’re still at significant risk, and medication can help reduce this risk.
Preventing future health issues: If you’ve had previous heart issues, diabetes, or other conditions that affect your heart health, taking cholesterol-lowering medication can be an essential part of your long-term care plan, even if your cholesterol is currently not high.

What are statins and how do they work?

Statins are a type of medication that lower your cholesterol levels by reducing the amount of cholesterol your liver produces. They are highly effective in preventing heart attacks and strokes, particularly in people who are at high risk. But statins do more than just lower cholesterol.

The additional benefits of statins

Statins have been shown to offer several benefits beyond just lowering cholesterol:

Reducing inflammation: Chronic inflammation in your blood vessels can lead to the development of plaques that cause heart attacks and strokes. Statins help reduce this inflammation, providing added protection to your cardiovascular system.
Stabilising plaques: If you already have plaques (fatty deposits) in your arteries, statins can help stabilise them, making them less likely to rupture and cause a heart attack or stroke.
Improving blood vessel function: Statins improve the health of the inner lining of your blood vessels, which can enhance blood flow and reduce the risk of blood clots forming.
Lowering the risk of blood clots: By reducing the likelihood of blood clot formation, statins help protect against strokes and heart attacks .

These additional benefits mean that even if your cholesterol level isn’t particularly high, statins can still play a crucial role in reducing your overall cardiovascular risk.

What about side effects?

For people at significant risk of cardiovascular disease, the benefits of statins in helping to reduce the risk of strokes and heart attacks generally outweigh the risk of side effects.

The vast majority of people taking statins do so without experiencing any problems. However, like any medication, there can be side effects that affect some people.

To read more about these, click the link below:

Statins – Side effects – NHS (www.nhs.uk)

Are there any alternatives to statins?

Statins are the first-line treatment for lowering cholesterol and reducing cardiovascular risk. However, for patients who genuinely cannot tolerate statins and are at high risk of cardiovascular disease (CVD), OR where a statin alone has not reduced cholesterol levels sufficiently, alternative treatments are now available. These options are only suitable in specific situations, and some require specialist input.

Ezetimibe – Can be used alone or in combination with a statin to further lower cholesterol. It works by reducing cholesterol absorption in the intestine and is often the first alternative if statins are not tolerated.
Bempedoic acid – A tablet that works in a similar way to statins but is less likely to cause muscle-related side effects. It may be considered for patients who cannot tolerate statins or need additional cholesterol reduction. It is often used in conjunction with ezetimibe.
Inclisiran – A twice-yearly injectable treatment that helps lower LDL cholesterol by reducing PCSK9 protein levels. This is generally only considered for patients with high cardiovascular risk who have not achieved target cholesterol levels with oral treatments.
PCSK9 inhibitors – Injectable medications used in patients at very high risk, typically for secondary prevention (i.e., those who have already had a heart attack or stroke) and who cannot lower their cholesterol sufficiently with the above treatments.

If we have contacted you about starting cholesterol-lowering medication and you have not been able to manage with statins in the past, please do respond, as you may be eligible for one of the other treatments outlined above.

I’ve read through the information, what now?

If you wish to start medication, use the link in the SMS you received to let us know. One of our clinicians will then review your medical record to determine the best treatment and issue a prescription, which we’ll send to your nominated pharmacy electronically. If we need to speak to your for a further discussion, we’ll arrange that.

Three months after you start treatment, we will arrange to check some blood tests, and if all is well, we can then add the medication to your repeats list for regular ordering.

If you’re not quite sure what to do, or wish to discuss further with one of our clinicians, use the link in the SMS to let us know and we’ll arrange an appointment for you.

Further information

If you would like to learn more about managing your cholesterol and reducing your risk of heart disease, here are some helpful resources:

NHS – Medications for high cholesterol

NHS – Cardiovascular Disease

Heart UK – The Cholesterol Charity

Your health is our priority, and we’re here to support you in making the best choices for your health. If you have any questions or concerns, please don’t hesitate to contact us.

Dr Mohamed Bhamani, GP Partner, Leylands Medical Centre

Last reviewed April 2025