Statins: doctors attack plans to increase prescriptions

Jun 11, 2014

Eight leading doctors object to plans to prescribe statins to people with a low risk of heart disease

A group of leading doctors has hit out at a proposal to prescribe statins to people with a low risk of heart disease. Eight doctors and academics, including Sir Richard Thompson, president of the Royal College of Physicians, have written to the National Institute for Health and Care Excellence (Nice) and Health Secretary Jeremy Hunt warning that new draft guidance will result in the "medicalisation of five million healthy individuals".

They have accused Nice of relying on "hidden data" funded by pharmaceutical firms to reach its conclusions and wants the evidence to be analysed by independent experts. The experts say they do not believe the benefits of statins outweigh the side effects, but Nice has firmly disagreed. Prof Mark Baker, director of the centre for clinical practice at Nice, told The Guardian that its proposals are intended to "prevent many lives being destroyed" through cardiovascular disease.

It comes as two articles published by the British Medical Journal suggesting statins may have harmful side-effects for one in five people are investigated by a panel of experts after being accused of "scaremongering".

So what exactly are statins? 
They are a group of medicines that can help lower rates of "bad cholesterol" in the blood by curbing the production of low-density lipoprotein cholesterol inside the liver. A high rate of this type of cholesterol is believed to be potentially dangerous as it can lead to the hardening and narrowing of arteries, which increases the risk of strokes and heart attacks. Cardiovascular disease is the leading UK killer, claiming around 180,000 lives a year. The NHS estimates statins save 7,000 lives a year.

Who takes statins? 
Doctors are currently supposed to offer statins to people who have a 20 per cent chance of developing heart disease. This accounts for around seven million people. The risk is calculated using factors such as age, sex, weight and whether or not a person smokes. In February, the National Institute for Health and Care Excellence (Nice) suggested that people with a ten per cent risk should be offered statins, to help save more lives. This would mean the vast majority of men aged over 50 and women aged over 60 would be taking the drug, around 12 million in total. The proposal follows new US guidelines that say anyone with a 7.5 per cent risk should be considered for the drugs. 

How much do statins cost? 
The NHS currently spends around £450m a year on statins. If the draft recommendations go ahead, this bill will increase substantially. However, the drugs have become significantly cheaper to buy over the years and, long-term, the move could save the NHS money if it prevents thousands more heart attacks and strokes.

What are the downsides?
The benefits of statins for healthy people have long been disputed by experts, as have the extent of harmful side effects, which include problems with muscles, liver and kidneys, cataracts, type 2 diabetes, memory loss and sleep disturbance. Some doctors think statins should be offered to every man over 50 and every woman over 60, while others oppose the mass "medicalisation" of people who are not ill. The group of doctors that has written to Nice and Hunt claims that statins have been associated with a 48 per cent increase in the risk of diabetes in middle-aged women. Other potential side effects could include depression, fatigue and erectile dysfunction, they warn. One former GP, Dr Kailash Chand, told the BBC that 80 per cent of the risk of heart disease comes from factors such as smoking, lack of exercise and an unhealthy diet, and warned that statins might give people false assurances that they can continue with an unhealthy lifestyle.

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Statins: should millions more be taking cholesterol drug? I
advise caution. Playing around with cholesterol is dangerous. Dietary control is better.