Doctor Q&A: Are statins safe to take? Dr Renee Hoenderkamp answers all your burning questions

Are statins safe?

Doctor Hoenderkamp said: "Statins are definitely effective in lowering cholesterol, which if left too high for too long is a contributor to the risk of a heart attack or stroke. Therefore, for patients with stubbornly raised cholesterol that is not responding to lifestyle changes, diet and exercise, using a statin to lower that means that cardiac risk can be improved.

"So far so good. But statins are probably the one medication that almost everyone you meet has heard of and often has a view on (think multiple press stories on side effects). So it’s a great question.

"It is important to start this answer by mentioning that ALL medication, even a simple pain killer, has side effects and using a medication should always involve a consideration of side effects and potential risks balanced against the benefits for you. Only you can make that decision."

What are the benefits of taking statins?

Doctor Hoenderkamp said: "Statins lower cholesterol and decrease heart attacks and strokes and death from heart disease.

"Reviewsthat compare data across multiple studies conclude that statins reduce the risk of developing dementia by about 15 percent.

Are there any risks?

Doctor Renée Hoenderkamp said: "Muscle pain is the commonest cause of people stopping their statins. Studies show that 30 percent of people stop due to myalgia. However, there is good data to show that much of this is what is called ‘nocebo’ – the blaming of a medication for a side effect due to negative expectations. In reality, statins do cause myalgia, but studies show that it is likely to be seen in five percent of patients.

"There is some evidence that rarely people have developed memory loss or confusion while taking statins. These effects reverse once the statin is stopped. There is limited evidence to prove a cause-effect relationship and other studies have found that statins have no effect on memory.

"We also can’t ignore the evidence that statins may help with brain function in people with dementia. This is still being studied.

"Statins can occasionally affect the way that your liver works. Doctors will usually monitor your liver function before and during use and will only recommend stopping if the changes are above certain levels. Small increases in liver blood tests are considered acceptable.

"Not everyone who takes a statin will have side effects, but some people may be at a greater risk."

Risk factors include:

• Being aged 80 plus
• Being female
• Taking multiple cholesterol lowering medications
• Taking medicines that interact with statins

• Having kidney or liver disease
• Drinking too much alcohol
• Drinking grapefruit juice when taking statins
• Having hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS)

Are there any special considerations for women?

Doctor Renée Hoenderkamp said: "Women are more likely than men to get side effects from statins but there is evidence that women decline statins more than men when offered them. This could be because women associate men more with heart disease.

"Unfortunately, coronary heart disease kills twice as many women as breast cancer each year in the UK. Evidence also shows that women have a higher chance of an incorrectinitialdiagnosis after a heart attack and are less likely than men to receive recommended heart attack treatments. This almost certainly extends to statins and so women may be dying unnecessarily."

Does progesterone (in the form of norethisterone, and without taking oestrogen) help with the menopause? 

Doctor Renée Hoenderkamp said: "Menopause is defined by a woman not having periods for 12 months and the average age is 51 in the UK. When this point is reached, the female hormones oestrogen and progesterone diminish until they are not produced at all.

"Many women (85 percent) get a range of symptoms including hot flushes, joint pain, brain fog, insomnia, low mood, itchy skin, dry eyes and mouth, vaginal dryness, urinary symptoms. There are more than 40 symptoms and the majority of them are caused by the loss of oestrogen.

"The aim of HRT is to replace this oestrogen, which in most cases solves the symptoms. However, oestrogen also encourages the lining of the womb to build and to prevent this happening, in women with a uterus, progesterone is added to HRT to keep the womb lining thin. The main role of progesterone in HRT is therefore purely to counteract the womb lining thickening. Norethistrone is a synthetic progesterone called progestin.

"Although the progesterone role of HRT is primarily to suppress the womb lining, it does aid sleep in its body-identical form of micronised progesterone, because it is sedative, so this can be a welcome side effect for sleep deprived women. This sleep benefit is not found with norethistrone.

"However, norethistrone does appear to have bone density protective effect. As this is also a worry at menopause, this is to be welcomed. There are also some small studies showing micronised progesterone can help hot flushes so for women who are suffering who can’t take oestrogen this too is to be welcomed. It is not clear that norethistrone helps hot flushes.

"Overall, the role for norethisterone in HRT is limited and it is worth considering that progestins like norethistrone do bring a small increased risk of breast cancer. If a woman has a uterus and so needs a progesterone, the smallest risks are achieved by using micronised progesterone (utrogestan)."

Can I cure hair loss through my diet? 

Doctor Hoenderkamp said: "Hair is often a reflection of our health and nutrition so in broad terms the answer is yes but with some caveats! Hair loss can occur for many reasons, amongst those, hypothyroidism, hormone dysregulation, trauma; infection; auto-immune disease; genetics; chemotherapy; skin conditions and poor nutrition. So it goes without saying that if poor nutrition can affect hair loss, then nutrition can help it.

"Clearly the most important step is a diagnosis of what the cause of the hair loss is. If for example hypothyroidism is the cause, correcting the condition can reverse the hair loss. You could also eat a diet rich in iodine to support your thyroid in the process. Some conditions (e.g. scarring and traction alopecia) however are only reversible in the early stages, so it is important to seek medical advice as soon as you notice a problem.

"It is shown in studies that a deficiency in certain micronutrients may lead to hair loss. If you’re experiencing hair loss, I would always recommend getting tested for deficiencies in iron, vitamin D, zinc, B vitamins, and copper and then replacing any that are low either by diet or supplementation would be a good start."

What does Doctor Hoenderkamp recommend?

Iron

"A common deficiency that affects hair, so get this tested and even if in range, make sure it's optimal."

Zinc

"Crucial for hair follicle function and easy to test and replace if low."

Vitamin D

"Important for skin and hair conditions and shown in studies to promote hair regrowth.

"There are many claims made around biotin as a supplement for hair loss and many of my menopausal patients anecdotally report good results. Studies have shown benefit but only if you have a biotin deficiency so it is important to test for this first.

"In all of these vitamin deficiencies, researchers have found that the patients with hair loss are often low in one or more of these areas. So a healthy balanced diet and replacement of missing minerals/vitamins has to be a good thing as does seeking medical help as soon as you notice an issue."

Don't forget to send any burning questions you may have over to health@gbnews.uk and we'll publish Doctor Hoenderkamp's answers to your queries on GBNews.com/health every Friday.