Millions could be put on statins

Millions more healthy people could be put on cholesterol-lowering drugs.
Tuesday, 10 February 2009 Source: BBC

England's heart tsar Roger Boyle said the government's rationing body should look at the issue after a study showed statins nearly halve heart attack risk.

The research in Archives of Internal Medicine shows the drugs are even more effective than previously thought.

Under current plans around one in four adults aged over 40 is to be prescribed statins on the NHS. GPs will begin the risk assessments later this year.

As well as heart risk, they will check all patients aged 40 to 74 for stroke risk and kidney disease.

It is highly likely that the threshold for using statins in primary prevention will fall  Peter Weissberg of the British Heart Foundation

It is projected that 15 million people will benefit from the checks, which will be phased in over five years. A Department of Health spokesman said they expected the number of statin prescriptions to increase by 30% per year.

Similar checks already occur in Scotland for people living in the most deprived areas.

Current guidelines from the National Institute for Health and Clinical Excellence for England and Wales, and SIGN in Scotland, recommend that anyone judged to have a one in five or greater risk of developing cardiovascular disease over 10 years should be taking a statin drug.

But the latest study of nearly 230,000 people, by investigators at Maccabi Healthcare Services and Sackler Faculty of Medicine in Tel Aviv, Israel, shows the drugs also benefit those at even lower risk - one in 10 - of developing cardiovascular disease.

This, say the researchers, means even more people over 40 should be taking statin drugs, even if they have no obvious signs of illness - which is called primary prevention.

The drugs are already given to patients with cardiovascular disease (CVD) - secondary prevention. In England and Wales alone about four million people are on them.

Widening the net could mean between six and seven million people taking them.

Cost effective

Some experts believe we are already prescribing too many statins, and there is a danger of turning healthy people into patients and making them worry about their health unnecessarily.

But Professor Boyle, the national director for heart disease and stroke, said the move would save thousands of lives each year.

Statins are a relatively cheap medication - a month's supply for a patient can cost as little as £1.39 if doctors prescribe a generic rather than a brand-name drug.

But the price tag for the nation would be billions.

Professor Boyle told The Telegraph cost was "not an issue".

A Department of Health spokesman said the current guidelines recommend that "when therapy is initiated, the statin chosen should usually be of low acquisition cost".

Peter Weissberg of the British Heart Foundation said: "In the UK prescription of statins for primary prevention is currently confined to those considered to be at high risk of developing heart disease. As the evidence accumulates and statins become less expensive it is highly likely that the threshold for using statins in primary prevention will fall."

A NICE spokesperson said: "NICE is committed to ensuring that its guidance is up-to-date through a planned programme of reviews which consider all the relevant evidence published since the original guidance.

"In order to be completely confident that a review of the statins guidance is appropriate, we have asked consultees and commentators to inform us of any evidence that suggests a review would be beneficial.

"The deadline for comments on the review proposal paper closed yesterday and we hope to confirm at the end of March 2009 if the current NICE guidance on statins will be reviewed.

"Current NICE guidance recommends that statins are used either where there is clinical evidence of an individual having CVD, or where the risk of an individual developing CVD within 10 years is estimated to be 20% or greater."