GP says my 10 year heart risk is 11% and offered me a statin. I feel completely fine. How do you even decide on something like this?

First post, long time reader, mostly of the PSA thread because I'm 57 and that one is coming for me too.

Had my routine check in September. Blood pressure 138 over something, cholesterol "a bit up", never smoked, not diabetic, walk to work. Felt like a pass. Then the follow up appointment and the GP turns the screen round and there's a number: 11%. She explained it's my chance of a heart attack or stroke in the next ten years and that above 10% they offer a statin, and did I want to start one.

I didn't know what to say so I said I'd think about it. Now I've been thinking about it for a week and I'm no further on. 11% sounds low? Like 89% I'm fine? But she obviously thought it was worth mentioning. And it's 1% over the line, which feels like being told I'm a pass with a fail sticker on it.

Did anyone else get this number and how did you decide? I don't want to be on a tablet for life because of a calculator. I also don't want to be the idiot who said no.

Got a version of this and I'm the runner on here, so I had the full indignation phase. Dad had his heart attack at 61, my calcium score came back higher than I wanted, and the risk number did the rest.

The thing that helped me was turning 11% back into people. Picture a hundred of you, same age, same numbers. About eleven of them have a heart attack or stroke in the next ten years. Nobody knows which eleven. A statin doesn't make that zero, it shaves some off it. Whether shaving some off is worth a daily tablet to you is the actual question, and it's a fair question either way.

Ask her which inputs are doing the heavy lifting. Mine was mostly age, which I can't do anything about, and a bit of blood pressure, which I could. That made the conversation completely different. She was happy for me to have three months at the blood pressure first and recalculate.

Tomasz W. said:

it's 1% over the line, which feels like being told I'm a pass with a fail sticker on it

Tomasz, the line is real but it isn't a pass or fail line, and I think seeing why will make the decision easier.

The number your GP showed you is an estimate built from your age, sex, blood pressure, cholesterol, smoking status and a few other things, weighed against large populations followed over years. 11% means that in 100 people with your profile, about 11 would be expected to have a heart attack or stroke over the decade. The 10% figure is where guideline bodies have judged that, on average, the benefit of a statin starts to clearly outweigh the downsides. NICE in England and Wales suggests offering one from a QRISK3 score of 10%, and the U.S. Preventive Services Task Force recommends one for adults aged 40 to 75 with at least one risk factor at 10% or more, and calls 7.5% to 10% a selective decision. So at 11% you are close to a line where reasonable people choose differently, which is exactly why she asked you rather than told you.

Three things are worth taking back to her. First, which calculator and which inputs: if the blood pressure was a single reading on a rushed day, or the cholesterol is old, the number may move when they are repeated. Second, what would change the score: dgb's question is a good one, because blood pressure and cholesterol are inputs you can influence, age is not. Third, what she would expect a statin to do for someone with your particular numbers, in the same terms as the risk, out of a hundred people. Guidance also puts lifestyle changes first and generally supports a reassessment after they have had time to work, so asking for that is not refusing treatment.

I can't tell you whether to take it, because the right answer depends on your full history and how you weigh a daily tablet against a modest reduction in risk. That's a conversation for your GP, and you are clearly well equipped to have it. The cholesterol screening guide covers the lipid side of the inputs.

For what it's worth, 1% over the line is not the same as being told you are ill. It's being told you're in the zone where it's worth a conversation. You're having it. That's the system working.

Update, because I read a lot of threads with no ending while I was stewing on this.

Went back with the three questions. The blood pressure in the calculation was the one from the checkup, which was the morning I'd cycled in late. She had me do a week of home readings and the average was lower, and when she put that in the number dropped to just under 10%. The cholesterol was this year's, so no change there.

Where we've landed: no statin for now, walking a bit more, cutting back the evening beer, and a recheck of cholesterol and the score in the spring. She was clear it's not a "never", it's a "let's see where the controllable bits go first". I came out feeling like I'd made a decision rather than dodged one, which is all I wanted.