11/13/24, 8\:20 PM Guide | Statin counselling

Statin counselling

Table of contents

Opening the consultation

Introduce yourself to the patient including your name and role.
Con
Explain the purpose of the consultation\:
“ T o d a y w e w i l l d i s c u s s a t y p e o f m e d i c a t i o n c a l l e d a s t a t i n .
”
It is important to establish a good rapport and an open line of communication with the patient early in the consultation\:
h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o i n t e r r u p t a n d a s k m e .
”
“ I f y o u
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).

Ideas, concerns & expectations

A key component of counselling involves exploring a patient’s ideas, concerns and expectations (ICE).
Using ICE early in the consultation will allow you to gain insight into how a patient currently perceives their situation, what they
are worried about and what they expect from the consultation. Furthermore, creating an open and honest environment and
being sensitive to a patient’s thoughts and ideas will allow you to elicit the most relevant information from the patient, including
any misconceptions that may need addressing.
Ideas
“ H a v e y o u h e a r d o f s t a t i n s ?”
“ D o y o u k n o w a n y t h i n g a b o u t s t a t i n s ?”
“ D o y o u k n o w w h a t s t a t i n s a r e u s e d f o r ?”
Concerns
“ I s t h e r e a n y t h i n g a b o u t t a k i n g s t a t i n s t h a t w o r r i e s y o u ?”
“ W h a t’ s y o u r b i g g e s t c o n c e r n r e g a r d i n g t h e t r e a t m e n t a t t h e m o m e n t ?”
Expectations
“ W a s t h e r e a n y t h i n g , i n p a r t i c u l a r , y o u’ d h o p e d w e w o u l d d i s c u s s t o d a y ?”
“ W h a t w o u l d n e e d t o h a p p e n f o r y o u t o f e e l t o d a y’ s c o n s u l t a t i o n w a s a s u c c e s s ?”
“ W h a t d o y o u h o p e s t a t i n s m i g h t b e a b l e t o d o f o r y o u ?”

Patient history

Although the purpose of this station is to counsel the patient, it is a good idea to gather a quick, focused history early in the
consultation.
Statins are commonly prescribed for adults who have been identi
prevention), or for those who have known CVD, such as those who have previously had a heart attack or stroke (secondary
1
prevention>). Knowing why they have been started on the medication can assist you in explaining why it is important they take
it.
It is also helpful to screen for CVD risk factors, including smoking, alcohol, hypertension, and having a sedentary lifestyle.
Taking a social history can help you in signposting the patient to any relevant lifestyle advice later in the consultation (e.g.
discussing smoking cessation if they are a smoker).
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QRISK

In primary care settings, the QRISK assessment tool forms an important part of the NHS health check and is used to estimate a
patient’s 10-year risk of developing CVD over the age of 40.
In England, clinicians are advised to use a 10% threshold to guide decision making around the commencement of statin
therapy for the primary prevention of CVD.
According to current NICE guidance, people found to have a risk of 10% and above should be o
therapy (e.g. atorvastatin 20mg) in addition to lifestyle modi
2
Example
“ A 1 0 % e s t i m a t e d Q R I S K s c o r e m e a n s y o u h a v e a 1 i n 1 0 c h a n c e o f d e v e l o p i n g c a r d i o v a s c u l a r d i s e a s e , s u c h a s m y o c a r d i a l
i n f a r c t i o n , s t r o k e o r a n g i n a , o v e r t h e n e x t 1 0 y e a r s . W h i l s t i t c a n n o t p r e c i s e l y p r e d i c t w h a t w i l l h a p p e n , i t d o e s gi v e u s a n
o p p o r t u n i t y t o d i s c u s s y o u r i n d i v i d u a l r i s k s a n d a c t i v e l y l o o k t o r e d u c e t h e m , f o r e x a m p l e b y s t a r t i n g a s t a t i n .
”
Those below the 10% threshold may have a lower 10-year risk of developing CVD, however, opportunities should not be missed
to further reduce this risk. For example, lifestyle modi
up QRISK re-assessments every 5 years.

What are statins?

Statins are a group of lipid-lowering drugs used to reduce the risk of atherosclerosis and related CVD events.
Statins work by inhibiting a key enzyme in the liver, HMG-CoA reductase, causing a decrease in hepatic synthesis of
cholesterol. This, in turn, increases the expression of hepatic cholesterol receptors, increasing uptake of low-density lipoprotein
(LDL) from the blood to the liver, resulting in a fall in plasma cholesterol.
3
Ensure you use patient-friendly language when explaining this.
Example
“ C h o l e s t e r o l i s e s s e n t i a l f o r l i f e a s i t i s u s e d i n m a n y p r o c e s s e s w i t h i n t h e b o d y . H o w e v e r , t o o m u c h o f t h e c h o l e s t e r o l c a n i n c r e a s e t h e r i s k o f p o t e n t i a l l y f a t a l c a r d i o v a s c u l a r e v e n t s s u c h a s h e a r t a t t a c k o r s t r o k e .
"
‘ w r o n g s o r t’ o f
" S t a t i n s w o r k b y l i m i t i n g t h e p r o d u c t i o n o f n e w c h o l e s t e r o l w i t h i n t h e b o d y , a s w e l l a s c l e a r i n g ‘ b a d c h o l e s t e r o l’ f r o m t h e
b l o o d . T h i s a i m s t o r e d u c e t h e t o t a l a m o u n t o f b a d c h o l e s t e r o l c i r c u l a t i n g i n t h e b o d y a n d , i n d o i n g s o , r e d u c e s t h e
l i k e l i h o o d o f f u t u r e h e a r t a t t a c k s o r s t r o k e s .
”
Statins are most e
concentrations. Therefore, patients with concerning triglyceride levels may be prescribed a
if the LDL concentration has been adequately lowered.
4

How to take statins

Statins are prescribed in the form of tablets and there are several types. Atorvastatin is the most commonly prescribed statin,
other common statins include simvastatin and rosuvastatin.
1
Statins are usually taken as a once-daily dose. Simvastatin and pravastatin should both be taken at night, whereas atorvastatin
and rosuvastatin can be taken at any time in the day; although, ideally, the timing of the statin dose should remain consistent
throughout treatment.
If the patient misses a tablet, they should take it as soon as they remember. They should not take two tablets in one day.
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Monitoring

Prior to starting treatment, the patient should have a blood test to obtain pre-treatment cholesterol levels, as well as to check
liver function. They should then expect to have another blood test within three months of starting treatment and again at 12
months to monitor the e
Explain to the patient that while they will not feel the bene
taking the treatment consistently for maximum therapeutic bene
well as addressing their concerns, will also improve the likelihood of them adhering to the treatment regimen.

Side e

The main side e
be commonly reported in those taking statins and is not usually a cause for concern.
However, rarely, muscle toxicity can be a severe side-e
such symptoms to their GP promptly.
5
More common side e
Generally, statins are well-tolerated and their long-term safety is well proven. It is important to reassure patients of this as
negative media coverage is known to negatively in
CVD mortality.
3,6,7

Key interactions

There are some interactions with foods and other medicines that patients taking statins should be aware of.
For example, grapefruit can interfere with the e
this applies to their medication. Similarly, other medicines, including some antibiotics, immunosuppressants and
a
You should advise the patient to refer to their patient information lea
supplements with their GP or pharmacist.

Lifestyle advice

Statins work to reduce the risk of cardiovascular events in an individual in addition to a healthy lifestyle. You should stress to
the patient the importance of regular physical activity, choosing healthy foods, cutting out smoking and limiting alcohol
intake in helping to improve their cardiovascular health.
Explain that they should be aiming to exercise regularly. Ideally, this should be a physical activity of moderate intensity for a
minimum of 30 minutes, at least
and mobility and so reasonable adjustments should be suggested to the patient as even a little is better than none at all.
8
A healthy diet can bene
as type 2 diabetes and heart disease. Advise the patient to eat a balanced diet with fruits, vegetables and starchy foods
providing the bulk of most meals. Limiting intake of foods and drinks high in fat and sugar and swapping saturated for
unsaturated fats can be cardioprotective. Regular servings of oily
additions to the diet.
1,9
If the patient is a smoker, you should explain that smoking is a risk factor for atherosclerosis and provide further details about
local smoking cessation services.
Example
“T h e r e a r e w a y s y o u c a n i m p r o v e y o u r h e a r t a n d b l o o d v e s s e l h e a l t h a l o n gs i d e t a k i n g s t a t i n s . R e g u l a r p h y s i c a l e x e r c i s e
c a n h e l p m a i n t a i n a h e a l t h y w e i g h t , i m p r o v e s l e e p a n d m a n a ge s t r e s s , a s w e l l a s r e d u c e y o u r c h a n c e o f d e v e l o p i n g
c o n d i t i o n s s u c h a s t y p e 2 d i a b e t e s , c a r d i o v a s c u l a r d i s e a s e a n d j o i n t a n d b a c k p a i n . A c t i v i t i e s t h a t i n c r e a s e y o u r h e a r t r a t e ,
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s u c h a s w a l k i n g , c y c l i n g a n d p l a y i n g s p o r t s , d o t h e h e a l t h i e r y o u r h e a r t w i l l b e c o m e .
"
a r e t h e m o s t b e n e
" A b a l a n c e d d i e t c a n a l s o b e n e
v e g e t a b l e s , e a t i n g u n s a t u r a t e d r a t h e r t h a n s a t u r a t e d f a t s , c h o o s i n g w h o l e gr a i n f o o d s a n d c u t t i n g d o w n a l c o h o l
c o n s u m p t i o n . H a v e a l o o k o n l i n e f o r l o t s o f i d e a s a n d r e s o u r c e s a b o u t h e a r t-f r i e n d l y a c t i v i t i e s a n d f o o d s .
”

Closing the consultation

It is good practice to summarise the key points at the end of the consultation to check the patient’s understanding and
address any remaining questions.
You should also provide the patient with a lea
relevant NHS web page), so they can read this in their own time.
Make sure to thank the patient for their time at the end of the consultation.
Example
“T o s u m m a r i s e , s t a t i n m e d i c a t i o n w i l l h e l p t o l o w e r y o u r c h o l e s t e r o l a n d r e d u c e t h e r i s k o f c a r d i o v a s c u l a r e v e n t s , s u c h a s
h e a r t a t t a c k o r s t r o k e , s o l o n g a s y o u t a k e i t r e gu l a r l y . Y o u’ l l n e e d t o t a k e t h e m e d i c a t i o n a t t h e s a m e t i m e e a c h d a y a n d
b e a w a r e o f a n y f o o d o r o t h e r m e d i c i n e s t h a t m a y a
m e d i c i n e s m a y a
Y o u s h o u l d a l s o s e e k u r g e n t m e d i c a l a d v i c e i f y o u h a v e a n y c o n c e r n i n g s y m p t o m s , l i k e t h o s e w e h a v e d i s c u s s e d .
"
" A l o n g s i d e y o u r s t a t i n m e d i c a t i o n , s t o p p i n g s m o k i n g , e a t i n g w e l l a n d e x e r c i s i n g c a n h e l p t o c u t y o u r r i s k o f c a r d i o v a s c u l a r
d i s e a s e a s w e l l a s i m p r o v e y o u r o v e r a l l h e a l t h a n d w e l l b e i n g . I a p p r e c i a t e t h a t I h a v e gi v e n y o u a l o t o f i n f o r m a t i o n f o r o n e
c o n s u l t a t i o n , s o I a m a l s o g i v i n g y o u a l e a
"
" A r e y o u h a p p y w i t h e v e r y t h i n g w e h a v e d i s c u s s e d a n d d o y o u h a v e a n y q u e s t i o n s f o r m e ?”

References

1. National Institute for Health and Care Excellence. C a r d i o v a s c u l a r d i s e a s e \: r i s k a s s e s s m e n t a n d r e d u c t i o n , i n c l u d i n g l i p i d
m o d i LINK]
2. National Institute for Health and Care Excellence. L i p i d m o d i
b l o o d l i p i d s f o r t h e p r i m a r y a n d s e c o n d a r y p r e v e n t i o n o f c a r d i o v a s c u l a r d i s e a s e . 2016. Available from\: [LINK]
3. Tidy, C. S t a t i n s a n d o t h e r L i p i d-l o w e r i n g M e d i c i n e s . Edited August 2017. Available from\: [LINK]
4. British National Formulary. Dyslipidaemias. 2020. Available from\: [LINK]
5. Medicines and Healthcare products Regulatory Agency. S t a t i n s \: b e n e LINK]
6. National Institute of Health and Care Excellence. O u r s t a n c e o n \: S t a t i n s . [no date]. Available from\: [LINK]
7. Nielson SF, Nordestgaard BG. N e g a t i v e s t a t i n-r e l a t e d n e w s s t o r i e s d e c r e a s e s t a t i n p e r s i s t e n c e a n d i n c r e a s e m y o c a r d i a l
i n f a r c t i o n a n d c a r d i o v a s c u l a r m o r t a l i t y \: a n a t i o n w i d e p r o s p e c t i v e c o h o r t s t u d y . Eur Heart J. 2016 Mar 14; 37(11)\: 908-16. from\: [LINK]
Available
8. UK Chief Medical OLINK]
9. Public Health England. T h e E a t w e l l G u i d e . September 2018. Available from\: [LINK]
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Source\: geekymedics.com
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