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Q1: Is there any merit in taking statins at my age of 82? My last cholestrol reading was 6.1 and has never been above this figure. Those that I have taken seem to upset my bowels - I suffer with IBS and some incontinence. Your advice would be very welcome. Joan Cousins, Newhaven.

A: The idea that cardiovascular disease is not worth treating in an elderly patient is an outrageous one that should have been forgotten once the Nuremburg trials were over. Central rationing of medical resources in which the elderly were given a low priority was a feature of Hitlerian planning in wartime Germany and has no place in modern Britain. A woman of 82 may still have many years of life ahead of her. Conversely of course, if statins had so altered the consistency of a patient's faeces, as they sometimes do, it could be the patient and her doctor would have to balance the certain discomfort that this was causing as the result of taking statins against the possible likely benefits that they will afford the patient by enabling her to live longer with a reduced likelihood of heart and stroke problems.

When deciding to take any statin it is worth remembering that the different members of each of the different types of statin in this large group of drugs have slightly different side effects. Switching from one statin to another will sometimes solve the difficulties that have been caused by a particular statin.

Recently NICE, the Government body that controls doctors' prescribing, approved the use of Ezetrol (ezetimibe) to be used with a statin so that a smaller dose of the statin may be used to achieve the same effect.

I hope that you are also having attention for your incontinence. Amazing what can be done about this now.

Q2: I have high blood pressure but not heart disease. My doctor told me to take simvastatin so I took a tablet one morning. The next morning I couldn't sit up in order to get out of bed so I had to roll over sideways and fall out. I told the doctor that the muscles in my stomach were affected and asked if I could have a different type of statin but he said all statins caused muscle cramps. I have not taken any statins since. Probably all other statins are more expensive. Name and address withheld.

A: Your doctor knows your case and you should therefore take their advice. However, speaking generally, it is fair to say that although statins have similar side effects the exact nature of these varies from person to person and product to product. The rule is to start with a low dose of whatever statin has been selected for the patient and to increase it slowly until the desired effect has been achieved. The correct dose for a patient is the lowest one possible that achieves the agreed target of the therapy. It is always worthwhile switching from statin to statin if either of these targets are not reached or if a patient has side effects. Likewise if the patient is having trouble from side effects or in achieving the desired target the statin should be combined with Ezetrol (see question one). If a patient can't manage to take any statin without impossible side effects Ezetrol can be used as monotherapy, that is to say it is used by itself without the statin.

Many statins cause myalgia - aching muscles. Muscle weakness and tenderness is one of the few, but luckily rare, side effects of statins but can be important. Fortunately there are relatively simple blood tests that will demonstrate to your doctor whether any muscle pain is a result of the relatively unimportant myalgia, important muscle problems associated with tenderness or weakness, or muscle troubles from a quite unrelated cause.

Q3: I wonder if you might explain if statins actually prevent any further build up of blockage in arteries, or clear it, or maybe neither? I have heard both ideas put forward and am curious to know. The context of this query is that I have taken Imvastatin for 18 month after a 20 percent blockage found in one artery to the heart. I also take aspirin - plus four other drugs for hypertension - and feel very well. Name and address withheld.

A: You have raised some very interesting questions. May I answer them point by point? Statins prevent the furring up of arteries, and if they are already furred up it certainly limits further increase in the deposits of the clogging fat (atheroma). It is estimated that statins save about 10,000 lives a year in Britain. Statistics also show that if someone is taking statins and perseveres with this their chances of developing serious heart disease is reduced by 40 percent. There's also no doubt that in some cases statins do actually reduce the amount of fatty atheroma that is clogging the arteries. It is a proud boast of mine that it was with one of the patients from my practice that the Royal Brompton Hospital were first able to demonstrate with scans the reduction in the blockage in crucially important arteries that occurred after a patient started to take statins. The patient, a middle-aged man who had previously been symptom free, began to take statins and his arteries that had been dangerously clogged up became relatively free flowing.