Millions more people in the UK should take statins – according to the National Institute for Health and Care Excellence (Nice). In its recent guidance to the NHS the advisory body has cut the threshold in half for when doctors should consider prescribing the drugs, to prevent more cases of heart attacks and strokes. Already around seven million people in the UK take statins, but if the new guidelines are put into practice this could rise significantly – with experts estimating another five million people may be prescribed the cholesterol-lowering drugs.
Statins are a group of medicines that help lower rates of low-density lipoprotein (LDL) cholesterol, the so called “bad cholesterol” in the blood by reducing its production in the liver. High-rates of LDL cholesterol are linked to hardening and narrowing of the arteries, which can cause heart disease, heart attacks and stroke.
Doctors used to prescribe statins only to those who had a 30% or greater risk of suffering a heart attack within a decade (as assessed by a range of indicators such as weight, blood pressure, cholesterol levels etc). This was lowered to those with a 20% risk in 2005, but now medics could be prescribing statins to those with just a 10% risk.
The reasons for the change are the proven benefits of statins in lowering cholesterol, and hence the cardiovascular disease risk, but also the fact that the cost of statins has greatly reduced over recent years. The tablets now cost only a few pence per pill meaning it could be more cost effective to treat people earlier to prevent them from developing heart disease which is more costly to treat – thus reducing NHS expenditure.
A 2012 Oxford University study, published in The Lancet medical journal, showed that even very low-risk patients benefited from statins.
However, as with all medicines there are concerns, one being that with so many potential people being advised to take statins this would in effect be ‘medicalising’ the population. Some cardiologists say there is limited evidence for whole scale prescribing of statins to relatively healthy people and that having so many people taking the drugs also means exposing them to the potential side effects of statins. Instead, they should be used only in those patients who would be most likely to benefit.
The new Nice guidance recommends doctors should encourage at-risk patients to make lifestyle changes to reduce their cholesterol and blood pressure first, such as stop smoking, cut down on alcohol, take exercise and eat a healthy diet. Once these factors have been addressed, high intensity statin therapy should be offered to patients. The doctor will be able to discuss with their patients what benefits they might get from statins but the final decision will always be with the patient.
Cardiovascular disease is the leading cause of death in England and Wales – figures show that 1 in 3 people died from it in 2010.