Cholesterol, statins and cardiovascular risk
A cholesterol result is not read on its own. What counts is the whole picture of cardiovascular risk: LDL cholesterol alongside blood pressure, smoking, diabetes, age and family history. Statins such as atorvastatin and simvastatin lower LDL and are prescription only in Malta. This page explains how they work, which blood tests are expected while you take one, what to do about muscle aches and when a repeat prescription is not the right answer.
What the numbers mean
A lipid profile usually reports total cholesterol, LDL, HDL and triglycerides. LDL is the fraction that drives the deposits in artery walls, which is why treatment is judged mainly by how far it falls.
A result is read together with the rest of the risk picture: blood pressure, smoking, diabetes, kidney disease, age, sex and a family history of early heart disease. The same LDL value means different things in two different people.
Targets are individual and are set by the doctor for the person in front of him, not by a general figure on a web page. Someone who has already had a heart attack is treated towards a lower target than someone with no other risk factor.
There is more about the causes, the tests and what raises cholesterol on /health-guide/high-cholesterol/.
How statins work and which are used
Statins block an enzyme the liver uses to make cholesterol, so the liver takes more LDL out of the blood instead. Atorvastatin, the substance in Lipitor, and simvastatin are both used in Malta, and rosuvastatin products are marketed here as well. There is more on /medicines/lipitor/ and /medicines/simvastatin/.
Statins differ in strength at the same milligram dose, so moving from one to another is not a simple swap of the number on the box. The doctor chooses the substance and the dose together, and a pharmacist may offer an interchangeable product with the same substance, strength and form.
Where a statin alone does not bring LDL down far enough, ezetimibe is sometimes added, including as a fixed combination with atorvastatin marketed as Atozet. A combination is one prescription and two medicines.
Statins are taken long-term. They work while they are being taken and the effect is not stored up, which is why continuity matters more than the precise hour of a single dose.
Which blood tests are expected
A lipid profile before starting, and again after a change of treatment, is the usual way the effect is judged. Once the result is stable the interval between tests grows longer, and the doctor sets it.
Liver enzymes are measured before starting and are checked again if symptoms appear or if the dose is raised. A mild rise is common and does not by itself mean the medicine has to stop.
Kidney function, blood sugar and thyroid function are sometimes included, because each of them changes how the result is read and how the medicine behaves. Creatine kinase is measured when there are muscle symptoms rather than as a routine.
For a repeat what the doctor needs is a recent result with a date on it, not a remembered value. Without it the assessment cannot be closed, because closing it would mean continuing treatment without knowing whether it is working.
Muscle aches and other side effects
Muscle ache, tenderness or weakness is the side effect people report most. It is usually mild, often affects the thighs, shoulders or back on both sides, and frequently turns out to have another cause entirely.
The right response is to report it, not to stop the tablet on your own. A doctor can measure creatine kinase, look for another explanation, lower the dose, change the statin or pause it briefly to see whether the symptom really follows the medicine.
Severe muscle pain together with dark urine, fever or a general feeling of illness needs urgent medical assessment, because serious muscle injury, although rare, is a recognised risk. New or worsening weakness that makes climbing stairs hard also needs to be looked at.
Statins interact with a number of medicines, among them certain antibiotics and antifungals, and for some of them with grapefruit juice. Tell the doctor everything you take, prescribed or not, including supplements. Other reported effects include headache, digestive upset and disturbed sleep, and the leaflet in the box lists them in full.
Is a statin taken for life, and can it be stopped?
A statin is taken for as long as the risk it addresses is there, which for most people means indefinitely. It is not a course with an end date built into it.
Stopping brings LDL back to roughly where it was before, because the medicine does not change the underlying tendency. That is why an unplanned stop is worth discussing with a doctor rather than deciding alone.
There are sound reasons to stop or pause: a side effect that does not resolve, an interaction with another medicine, pregnancy or planning a pregnancy, or a new serious illness. Each of those is a medical decision.
Eating, activity, weight and not smoking are not an alternative to the medicine, and the medicine is not an alternative to them. They act on the same risk from different directions, and the plan usually needs both.
What a repeat needs, and when it is not enough
A repeat is for a dose that a doctor has already established and that you tolerate, with a recent lipid profile and liver enzymes and no new symptoms. The doctor needs the name and strength, the dosage, who started it and when, and the last results with their dates.
It is not enough for a first prescription, because starting treatment means assessing overall cardiovascular risk, and that needs an examination and a plan.
It is not enough after a heart attack, a stroke or a new diagnosis of coronary disease, when the whole treatment is being set, nor alongside new chest pain, breathlessness or palpitations. Chest pain and breathlessness are emergencies: call 112 or go to Accident and Emergency.
Pregnancy, breastfeeding and planning a pregnancy change the assessment, and so do significant liver disease and a previous serious muscle reaction to a statin.
What a pharmacist checks
Dispensing is a professional decision taken by the pharmacist. He or she checks the identity of the person collecting the medicine, whether the details on the document are complete and legible, and whether what is prescribed fits the information available, and may refuse where something is doubtful.
We cannot promise that a pharmacy will dispense against our document. That discretion is a safeguard and it applies to a document from any source, wherever it was written.
A pharmacist may offer an interchangeable product with the same active substance, strength and form. With statins that is common, because the same substance is marketed under several names; the Medicines Authority publishes which medicines are authorised and marketed in Malta.
Entitlement under the public scheme is assessed separately from dispensing, so expect to pay the pharmacy price for a medicine dispensed against a document created outside the Maltese system. There is more on /blog/eu-prescription-maltese-pharmacy/ and on /blog/prescription-validity-malta/.
What we offer and what we do not offer
We offer a medical questionnaire and a doctor's review of treatment that is already established. The route is /repeat-prescription/ and the review costs 24,90 €; priority handling is an extra 9,90 €, which means a place in the queue and not a promised date.
The document is a cross-border prescription in the format set out in the Annex to Directive 2012/52/EU, and you receive it as a PDF by email to print or show on screen, together with photo identification. It is not written into any Maltese state record and is not visible in myHealth.
It is issued by lek. Damian Wojno, registered with the Polish Medical Chamber, licence no. 3211301. He is not registered with the Medical Council of Malta, which keeps the register of doctors practising here, and he does not take over the role of your family doctor or of a cardiologist.
We do not offer video calls, telephone consultations or live chat. We do not start statin treatment, we do not read a first lipid profile as a diagnosis, we do not issue medical certificates and we do not handle mental health problems. The fee covers the doctor's review, not the issuing of a document and not the price of the medicine at the pharmacy. If the doctor decides on medical or legal grounds that a prescription is not justified, we refund the fee, and the same applies when the assessment cannot be completed. There is more about the fee on /blog/online-prescription-cost-malta/.
By how much do statins lower cholesterol?
There is no single figure to quote. How far LDL falls depends on the substance, the dose and the level you started from, and statins differ in strength at the same milligram dose. That is why the result is judged from a repeat lipid profile rather than from a general percentage, and why the target is set individually by the doctor.
Which blood tests are needed?
A lipid profile before starting and again after a change of treatment, and liver enzymes before starting and when symptoms appear or the dose is raised. Kidney function, blood sugar and thyroid function are sometimes included. Creatine kinase is measured when there are muscle symptoms, not as a routine. For a repeat the doctor needs a recent result with its date.
What causes muscle aches?
Muscle ache on a statin is usually mild, often affects the thighs, shoulders or back on both sides, and frequently has another cause entirely. Report it instead of stopping the tablet: a doctor can measure creatine kinase, look for another explanation, lower the dose, change the statin or pause it briefly. Severe pain with dark urine or fever needs urgent assessment.
Is a statin taken for life?
For most people, yes, in the sense that it is taken for as long as the risk it addresses is there. It is not a course with a built-in end date. The medicine works while it is being taken, and stopping brings LDL back to roughly where it was before, because the underlying tendency has not changed.
Can a statin be stopped?
It can, but that is a medical decision rather than one to take alone. Sound reasons include a side effect that does not resolve, an interaction with another medicine, pregnancy or planning a pregnancy, and a new serious illness. Discuss it with a doctor, because stopping returns LDL to roughly its earlier level and changes the risk the treatment was addressing.
Can a first statin prescription be issued this way?
No. Starting a statin means assessing overall cardiovascular risk, which needs an examination, blood tests and a plan, and that cannot be done from a questionnaire. This route is for continuing a dose that a doctor has already established and that you tolerate, with a recent lipid profile and liver enzymes and no new symptoms.
Will a pharmacy dispense it?
That cannot be promised. Dispensing is decided by the pharmacist, who checks identity and the completeness of the document and who may refuse where something is doubtful. The pharmacist may offer an interchangeable product with the same substance, strength and form, which with statins is common. Expect to pay the pharmacy price in full.
What does the fee cover?
The doctor's review of your questionnaire, not the issuing of a document and not the price of the medicine at the pharmacy. The review costs 24,90 €, with priority handling for an extra 9,90 €. If the doctor decides on medical or legal grounds that a prescription is not justified, we refund the fee, and the same applies when the assessment cannot be completed.