Statins – more calls for wider use despite research showing ‘absence of evidence of overall benefit’

There’s something about statins that makes even the most intelligent doctor say silly things – such as that everyone over 40 should take them, even that children should be given them. Statins  have a reputation as  ‘wonder drugs’ for prevention of deaths from cardiovascular disease. The real wonder is how these drugs have become the biggest selling class of pharmaceutical compounds of all time, given that they aren’t definitely proven to do a very good job.  They are proven to have a very serious risk profile that includes memory disturbance, sexual dysfunction, cataracts and type 2 diabetes. Sure, there is scientific evidence to suggest that statins work very well, and side effects are ‘rare’. However,  this evidence is mostly industry funded.  Independent, gold-standard, scientific research suggests otherwise. It points to very real risks of statins, and  an ‘absence of evidence of overall benefit’. Yet clarion calls continue for ever wider use. It’s as if some doctors have ‘statin-induced amnesia’, as one specialist put it;  or they believe that cardiovascular disease is caused by a deficiency of statins in the body. US guidelines were recently revised to recommend more aggressive statin therapy for high-risk patients. Now Britain’s National Institute for Health Care and Excellence, (NICE for short) is in on the act, suggesting much wider use. Seems to me these specialists haven’t done their homework properly on the risk-benefit profile of statins, and that’s just not nice. MS

By Ben Hirschler

STATINS Doctors should use cholesterol-lowering statin drugs much more widely to prevent heart attacks and strokes, according to Britain’s healthcare cost-effectiveness watchdog.

In a major revision to 2008 guidelines, the National Institute for Health and Care Excellence (NICE) recommends the threshold for starting on statins should be halved from a 20% risk of developing cardiovascular disease over 10 years to a 10% risk.

An estimated 7 million people in Britain already take statins at an annual cost of around £450 million, and reducing the benchmark for treatment would increase that number significantly.

But increased use is viewed as a cost-effective strategy, since cardiovascular disease in England alone cost the state-run National Health Service (NHS) some £7.88 billion in 2010.

NICE said its new draft guidance, which is subject to consultation, reflected the latest medical evidence on heart risks as well as a fall in the prices of many statins in recent years thanks to generic competition. The agency assesses both cost and clinical effectiveness in determining whether treatments are worth using on the NHS.

“The effectiveness of these medicines is now well proven and their cost has fallen,” said Dr Mark Baker, director of the Centre for Clinical Practice at NICE.

Baker said people with high cholesterol also needed to eat less saturated fat and sugar, exercise more, lose weight and stop smoking.

The NICE proposals echo new US guidelines on heart health that recommend more aggressive statin therapy for high-risk patients.

NICE said the preferred drug for patients starting on statin therapy was atorvastatin, the chemical name for Pfizer’s popular Lipitor, which is now available as a cheaper generic. Most statins are now off patent and available as generics, although Britain’s AstraZeneca still has exclusivity on Crestor, a particularly potent statin and the company’s top-selling medicine.

Better drugs and prevention strategies such as anti-smoking campaigns have slashed death rates from cardiovascular disease in recent decades, say specialists.

In Europe, the death rate from cardiovascular disease has been halved over the past 30 years, while the risk of dying within 30 days of a heart attack has been cut by more than half in just 20 years.

Yet cardiovascular disease remains the number one killer in Britain and worldwide, including in South Africa, and many doctors fear a renewed epidemic of heart problems in 20 to 30 years as a new generation of overweight and obese youngsters reaches middle age. Reuters.


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