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[bombsh3ll]

Again if you plan to live more than 10 years, the lifetime risk calculation also by qrisk is more relevant.

The NHS is really only focused on treating those likely to already be in the prodromal decade before an end stage CVD event.

This is no longer really primary prevention, it is attempting to modify the course of already well established disease.

However I do believe that there are distinct subtypes within those with hypercholesterolemia.

There are those like me, or like Bella above with lifelong raised cholesterol, and those like Jules with a healthy lipid profile in youth that goes off with age or other acquired factors.

The latter group can probably afford to be less aggressive as their cumulative exposure to harmful lipids is lower overall.

Unfortunately the NHS approach is very much one size fits all, with most people never offered a cholesterol test in young adulthood, or abnormal results ignored even if one is done.

The risk prediction tools used also don't account for female-specific risk factors such as pregnancy complications or menopause, and place someone with a single male relative having an MI at 59 after smoking heavily and living off takeaway, in the same bucket as someone with multiple affected relatives of both sexes at much younger ages, all very fit non smokers.

[Jules]

All good points. I'm 67, my youngest son at 39 had higher cholesterol than me at his last blood test, he also takes BP medication, all I think genetic from his father's side. He refused statins. Im not even sure he gets an annual blood test.

[Minusminnie]

Could you explain is that 6.4% risk in the next ten years or a different result not a percentage.
I’ve now started atorvastatin at 12% risk in next ten years when at my age they want to see 10% or below.

https://www.qrisk.org/index.php

Thanks

[Bella247]

As someone with raised cholesterol since it was first tested at 24, when I was really slim and athletic with a clean diet, and a strong family history of the same, I believe the impact of lifestyle advice is extremely limited unless someone has a particularly unhealthy lifestyle to begin with.

That’s very interesting. It’s worth asking for a genetic test. I was only tested because my optician noticed a white ‘arch’s’ in my eye and I mentioned to the GP that my dad died in his 30s of a massive heart attack. It’s very common 1/250 people I believe. If you have it your child has a 50/50 chance (sadly mine does). If you have boy children it’s very well worth it (girls are protected to an extent by oestrogen, but it can cause very premature death in men as it did with my dad). He died in the 80s when they didn’t know much about these things. When they did the autopsy they discovered he’d had lots of mini heart attacks. It’s not ideal because I have health anxiety (likely triggered by my dad dying instantly when I was a child). If statins don’t work out there are other treatments. My consultant says it doesn’t matter how healthily I eat (although I should) my levels cannot be within safe levels through diet alone. It’s quite a struggle esp when menopause hits

People are too often made to feel like high cholesterol is their fault, when in reality it is as heritable as eye colour, and young women in particular are overlooked for statin treatment as "your risk of an end stage CVD event in the next 10 years is low".

That's fair enough if the patient is 75 or 80. In younger individuals, lifetime risk is a more appropriate outcome.

[Bella247]

I should say as someone with health anxiety (appreciate not everyone has this) I would steer well away from calculating my risk of dying. I do understand why some people want to assess the risk and I agree that statins are over prescribed but they’re not overprescribed for everyone and familial hypercholesterolemia is very very under diagnosed even now. I feel like I shouldn’t really say this as I wouldn’t like anyone to be reading this and be worried but you can ask for a genetic test and there are treatments available

[Jules]

I haven't calculated my risks of anything in the future. I stopped looking into the future when my marriage ended and all my future plans went out of the window. There's no point.  I do what I can in the present