Understanding Statins and Ezetimibe

Helping you reduce your risk of heart attack, stroke, and other cardiovascular diseases

🫀 What is Cardiovascular Disease (CVD)?

Cardiovascular disease is a group of conditions that affect the heart and blood vessels. These include:

• Coronary artery disease (angina or heart attacks)
• Stroke and transient ischaemic attack (TIA)
• Peripheral vascu​​lar disease (PVD)

These conditions are often caused by atherosclerosis, a process where fatty deposits (mainly cholesterol) build up inside the blood vessels, restricting blood flow. High cholesterol levels increase the risk of cardiovascular disease.

💊 What Are Statins?

Statins are medications that lower the amount of “bad” cholesterol (LDL) in your blood. They work by blocking an enzyme in the liver that your body uses to produce cholesterol.

Common statins include:

• Atorvastatin
• Simvastatin
• Rosuvastatin
• Pravastatin

Atorvastatin is usually recommended first line in the NHS due to cost effectiveness.

Rosuvastatin is our preferred statin as it is the most effective and tends to cause fewer side effects. Unlike atorvastatin, which is fat-soluble (lipophilic), rosuvastatin is water-soluble (hydrophilic) which limits its ability to enter cells including muscle. This is thought to lower the chances of side effects.

💊 What Is Ezetimibe?

Ezetimibe is another type of cholesterol-lowering medication. It works by reducing the amount of cholesterol your body absorbs from food in the small intestine. It is usually used when statins alone don’t lower your cholesterol enough, or if you cannot tolerate statins.

🧪 What Are Statins and Ezetimibe Used For?

These medicines are used to reduce your risk of cardiovascular disease by lowering your cholesterol.

They are prescribed for:

• People who’ve already had a heart attack, stroke, or other vascular disease (secondary prevention)
• People at increased risk of developing CVD based on risk calculators like QRISK3 (primary prevention)
• People with conditions like diabetes, chronic kidney disease, or hypercholesterolaemia

✅ What Are the Benefits of Statins and Ezetimibe?

Taking a statin every day can:

• Lower your LDL cholesterol by up to 50%
• Reduce your risk of heart attack, stroke, or death from CVD by about 25–35%
• Help stabilise and reverse plaque build up in the arteries, making them less likely to rupture

These benefits increase over time, especially if the medication is taken consistently.

🎯 What Is the Target for Cholesterol?

Your doctor will tailor your cholesterol target based on your individual risk.

As a general guide, if you have had a previous stroke or heart attack (secondary prevention) or have a condition like diabetes or chronic kidney disease which increases your cardiovascular risk, your treatment targets are:

• Total cholesterol: Ideally below 4.0 mmol/L
• LDL cholesterol: Ideally below 2.0 mmol/L

If you do not have any of these conditions, your treatment target is generally:

• Non-HDL cholesterol: a reduction of greater than 40% from baseline

🏃‍♂️ Things to Do While Taking Statins or Ezetimibe

Medication works best when combined with a healthy lifestyle

Statins are highly effective, but lifestyle changes can improve your cholesterol further and protect your heart.

Here’s what you can do to get the most benefit:

🥗 Eat a Heart-Healthy Diet

Focus on a Mediterranean-style diet, which has been shown to reduce cardiovascular risk:

• ✅ Plenty of vegetables and fruit – aim for at least 5 portions a day
• ✅ Wholegrains – choose wholemeal bread, oats, brown rice, and pasta
• ✅ Healthy fats – use olive oil or rapeseed oil instead of butter or lard
• ✅ Oily fish – like salmon, mackerel, or sardines (1–2 portions per week)
• ✅ Nuts and seeds – in moderation, as part of a balanced diet

Limit or avoid:

• ❌ Saturated fats – reduce intake of red meat, butter, cream, cheese
• ❌ Trans fats – often found in processed snacks and baked goods
• ❌ Excess salt – aim for less than 6g (1 tsp) of salt per day
• ❌ Added sugars and refined carbs – like sugary drinks and white bread

🚶‍♀️ Stay Physically Active

Aim for:

• At least 150 minutes of moderate-intensity activity per week, such as brisk walking, cycling, or swimming
• Include 2 sessions of muscle-strengthening activity (e.g. resistance exercises or yoga) each week
• Reduce time spent sitting – try standing or moving around every 30–60 minutes

Even small increases in activity levels can have a positive effect on your cholesterol and heart health.

⚖️ Maintain a Healthy Weight

If you’re overweight, losing even 5–10% of your body weight can significantly improve your cholesterol levels and blood pressure.

Manual can also support you with weight management or lifestyle programmes. If you would like to speak to someone about this, click here.

🚭 Stop Smoking

Smoking dramatically increases your risk of heart attack and stroke. If you smoke:

• Ask your GP or pharmacist for help to quit
• Consider NHS Stop Smoking Services or use nicotine replacement therapy

🍷 Drink Alcohol Sensibly

Follow UK guidelines:

• No more than 14 units per week, spread across 3 or more days
• Have several alcohol-free days each week
• Avoid binge drinking, which raises blood pressure and triglycerides

💬 Remember: Combining statins with a healthy lifestyle gives you the best protection against heart disease. The goal is not just to lower cholesterol, but to improve your overall cardiovascular health.

⚠️ What Are the Side Effects of Statins?

Most people do not experience side effects. Statins are one of the most studied and widely used medications in the world.

Possible side effects (rare - less than 1 in 100 people):

• Muscle aches (usually mild and temporary, rate is similar to those taking placebo)
• Digestive issues (e.g. nausea, constipation)
• Elevated liver enzymes (monitored with blood tests)

Serious side effects like severe muscle damage (rhabdomyolysis) are very rare — around 1 in 100,000 people.

💬 If you experience new or unusual muscle pain, contact your doctor, but do not stop your statin without medical advice.

🚫 Things to Avoid While Taking Statins

• Grapefruit or grapefruit juice (especially with simvastatin or atorvastatin) – it can increase the risk of side effects
• Alcohol in excess – may increase liver strain
• Certain antibiotics and antifungals – let your GP know you’re taking a statin

Always check with your doctor or pharmacist before starting any new medications, including over-the-counter and herbal supplements.

💊 What Are the Side Effects of Ezetimibe?

Most people who take ezetimibe do not experience side effects. It is generally well tolerated, especially when used on its own. However, as with all medications, some people may experience mild effects.

Common side effects (affecting fewer than 1 in 100 people):

• Stomach discomfort – such as bloating, diarrhoea, or flatulence
• Tiredness or fatigue
• Muscle or joint pain – more commonly when combined with a statin
• Headache

📞 Need Help or Have Questions?

Reach out and speak to your doctor at Manual or one of our clinicians if you have concerns. It’s important to understand your treatment and feel confident managing your cholesterol.

📚 References and Further Reading

• NICE (2023). Patient decision aid: Should I take a statin? PDF
• British Heart Foundation. Statins. BHF Website
• Patient.info. Statins and other lipid-lowering medicines. Patient Info