The decision whether to start statin therapy should be made after an informed discussion between the clinician and the person about the risks and benefits of statin treatment, taking into account additional factors such as potential benefits from lifestyle modifications, informed patient preference, comorbidities, polypharmacy, general frailty, and life expectancy.

In addition to the lipid profile, baseline blood tests should include liver function, renal function, thyroid function and an HbA1c test for diabetes. This will help identify any contraindications and rule out any secondary cause of high cholesterol such as untreated hypothyroidism, nephrotic syndrome or liver and/or alcohol-related issues.

Simvastatin, pravastatin and fluvastatin should be taken in the evening or at bedtime but, due to their longer half-life, both atorvastatin and rosuvastatin may be taken at any time of day.

A re-assessment of lipid profile is undertaken after three months. If a greater than 40 per cent reduction in non-HDL cholesterol has not been achieved, or the ‘target’ cholesterol not attained, a discussion around adherence and lifestyle measures should be undertaken and, where appropriate, up-titration of statin dosage/potency or addition of other lipid lowering agents implemented.

Important

Statins can cause a serious muscle problem in a very small number of patients. If a patient suffers unexplained pain, tenderness or weakness in their muscles, they should stop taking the medicine and speak to their doctor immediately.