6th April 2026

Newsletter Monday

You know when something irks you because you keep seeing it misunderstood?

That’s how I feel when I read medical records that list high cholesterol as a medical problem.

High cholesterol is not a disease.

And yet, I still see it written in patients’ past medical history as if it sits alongside heart attacks, strokes, and cancer, by doctors that should know this.

It takes every ounce of restraint not to reach for a red pen and cross it out like a teacher marking homework.

No one dies from just “having high cholesterol.” Something else has to happen.

Cholesterol is a risk factor, it is not a disease.

It contributes to a process that develops over years. On its own, it doesn’t cause symptoms.

It doesn’t suddenly strike on a Tuesday afternoon. But it persistently gets mislabelled for one reason.

Statins exist.

They’re widely prescribed. They change numbers.

But how and when they’re used varies and so do their effects.

Statins in Primary prevention

This is the term we use in healthcare when nothing has happened.

No heart attack. No stroke. You want to prevent a “primary event”.

We’re looking at your overall risk of something happening in the future and asking:

You have probably been invited to have that conversation and I can say with certainty, it probably didn’t get as much discussion and attention as it deserves.

Because whether or not you opt in to taking a statin for primary prevention is highly personal.

​Your individual risk score will be calculated, your age will play the biggest role in terms of how high you risk is.

It may come as a shock but getting older remains the number one risk factor for dying in all things classed as “living”.

But there are multiple other factors to consider, including your own tolerance for risk.

Statins in Secondary prevention

This is different. Something has already happened.

A heart attack. A stroke. Established cardiovascular disease.

At this point, we are no longer dealing in theory. We want to prevent a second event.

So the question changes to:

This is where statins make more immediate sense, and the numbers in the calculator matter less.

If this seems counterintuitive, then it’s because there is a major benefit that people with existing disease derive from statins.

It is that of plaque stabilisation.

Statins help stabilise plaques in existing disease, making them less likely to rupture.

This effect is why plant sterols, as seen in cholesterol lowering spreads in the supermarket, don’t have any effect on disease mortality. Plant sterols can lower cholesterol numbers, but we don’t have good evidence that they reduce heart attacks or mortality in the way statins do.

So when someone says:

They’re missing the point.

This is also where social media advice tends to fall apart. It treats all statin use as if it’s the same.

As if everyone is being medicated for a mildly inconvenient blood test result. And then offers “natural alternatives” as though they’re interchangeable.

They’re not.

Lifestyle matters. Massively.

Food, activity, smoking, blood pressure, sleep, all of it.

But in someone who has already had a heart attack, that’s not a swap.

Then there’s age.

If you’re 80 and taking a statin purely for prevention, the picture becomes less clear.

We’re not running large trials in this group. So the balance of benefit versus burden becomes more individual.

At that point, it’s less about rigid rules and more about:

• overall health

• other conditions

• medication load

• and what actually matters to you

Where do you stand on statins doc?

I get asked about statins a lot. Usually in a very simple way:

As though I’m either for them or against them.

I’m neither.

I’m for people having clear, honest information and making decisions that fit their situation.

Quite often, when people email me about this, it’s not really a question about statins. It’s a question about whether they should be taking something at all.

And that’s understandable.

The amount of conflicting advice out there is enough to make anyone second guess themselves.

But that’s exactly why there isn’t a simple answer.

Because the right decision depends on:

• what’s already happened

• your overall risk

• your age and health

• how you feel about taking medication

The same drug can make complete sense in one person and very little sense in another.

So if you’re looking for a clear “yes” or “no” on statins, you probably won’t get one from me.

What I will always try to give you is enough clarity to make your own decision with confidence, Not pressure, not fear, and not a one-size-fits-all answer.