British Medical Journal Article Questions Plans To Increase Statin Prescriptions

| June 5, 2014

Earlier this year, the National Institute for Health and Care Excellence mooted the idea of a reduction in the threshold beyond which statin drugs should be considered (from a 10-year risk of cardiovascular disease of 20 per cent to 10 per cent). Some people believe this can only be a good thing. I believe these people are idiots and/or hopelessly biased. The fact is hardly anyone at low risk of cardiovascular disease will benefit from taking statin drugs. Does it make sense to squander scarce resources on something that is so hopelessly ineffective?

Last week, the British Medical Journal carried an interesting opinion piece from Professor Azeem Majeed – a general practitioner and professor of primary care based in London, UK [1]. In his piece, Professor Majeed details three major objections to the widening of statin prescription to people at lower risk.

His first point is that the proportion of the health budget spent on primary care (general practice) has fallen. Also, it is well accepted that primary care doctors and services are placed under increasing demand. He writes: “…despite already being overstretched and underfunded, general practices will have other major new areas of work to take on, such as hospital admission avoidance schemes, improved care for older patients, longer opening hours, and more rapid access for people with acute medical problems. General practices may not be able to cope with all these additional areas of work and at the same time further expand access to statins unless the government were to increase the funding that general practices receive.”

The second point Professor Majeed makes is that essentially healthy people may need to be persuaded to take statins. This observation resonates with me, as my experience tells me that most healthy individuals who take statins do so because they are scared not to. Usually, their doctor has given them a thoroughly jaundiced view of the value of statins and the likely benefits. My experience is that when individuals are given the facts (not rhetoric), they almost universally choose to give statins a miss. One could argue that if statins really were as effective as some doctors and researchers like to claim, then little persuasion would be necessary. It’s a sad state of affairs, I think, when patients are put under undue pressure and subjected to scare tactics in an effort to get them to ‘take the pills’.

The final point Professor Majeed makes concerns the thorny subject of side-effects. In essence, he asks if we really know what the risks of taking statins are. He draws our attention to the fact that there appears to be a higher incidence of side effects in real world settings compared to that yielded by clinical trials. But, as we know, there are many reasons why this may be so: trials can be designed, conducted and reported in a way that simply misses risks and adverse events. Professor Majeed comments that: “The discordance between the evidence from clinical trials and from clinical practice needs to be investigated so that doctors and patients are given accurate information about the risks and benefits of long term statin treatment.”

To my mind, this is a thoughtful piece about why some have major reservations about NICE’s planned change to the guidelines. It comes from someone who works on the front line, and perhaps knows the futility of trying to ‘sell’ to patients a treatment which is quite ineffective and the safety of which is in doubt.

Here's to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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References:

1. Majeed A. Statins for primary prevention of cardiovascular disease. BMJ 2014;348:g3491

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