Thousands ‘could be taking statins for no reason’ as 600% MORE people are eligible than 30 years ago but prescribing is less efficient
- Cholesterol-busting statins are the most prescribed medication in the UK
- But the ratio of low-risk patients treated to heart attacks prevented is widening
- One expert said only the highest-risk patients should be prescribed the pills
- Whereas others say it is too difficult to predict who will have a heart attack
- Because the highest-risk patients aren’t always the victims, prevention is key
Thousands of people could be taking statins without ever seeing a benefit, experts fear.
There are fresh concerns about the numbers of people considered eligible for the cholesterol-busting pills following recent research.
A study found the proportion of people who could be prescribed the drugs in Ireland has rocketed by more than 600 per cent in the past 30 years.
At the same time the number of patients doctors need to treat to prevent a single heart attack has risen, suggesting the guidelines are becoming less accurate.
Experts in the field are, as ever, divided on the subject – there are fears over-prescribing is doing ‘more harm than good’, as well as the opinion all prescribing is beneficial because it’s not possible to predict who will need protecting.
Statins have been proven to reduce the risk of heart attacks but are controversial among the medical community because of their potential side effects and effectiveness among people in low-risk groups (stock image)
Research by the National University of Ireland Galway looked at how the threshold for prescribing statins, which are proven to be lifesavers, has changed over time.
It found that in 1987 just eight per cent of the Irish population were eligible for the drugs, whereas this had shot up to 61 per cent by 2016 – a 663 per cent rise.
Meanwhile the number of people who need to be treated to prevent a single cardiac event – such as a cardiac arrest or heart attack – has risen.
In the lowest risk category, 400 people now need to be treated to prevent a single deadly event over any given five years. This was just 40 in 1994.
The ten-fold rise in the figure suggests lowering the bar has made statin treatment, overall, less efficient.
But it is almost impossible to predict who will have a heart attack, and it won’t always be the people who have the highest calculated risk, experts said.
In the highest risk category the drugs still remain extremely efficient, preventing a serious cardiac event in every 25 people treated over a five-year period.
Among high risk patients, between between 25 and 53 people need to be treated to avoid a single cardiac event, and, in the moderate risk category, between 53 and 400.
Professor Tim Chico, a cardiology expert at the University of Sheffield, said: ‘Since pretty much any adult can have a heart attack, particularly as they get older, this means unfortunately most of us would have our risk slightly lowered by statin treatment.
‘Unfortunately, we cannot estimate someone’s risk of a future heart attack very accurately, which means many people in the UK will have a heart attack today who would have been estimated to be at low risk yesterday.
WHY ARE STATINS CONTROVERSIAL?
Statins are the most commonly prescribed drug in the world and an estimated 30 per cent of all adults over the age of 40 are eligible to take them.
The cholesterol-lowering drugs are given to people believed to have a 10 per cent or higher risk of developing cardiovascular disease or having a heart attack or stroke within the next 10 years.
They are proven to help people who have suffered heart problems in the past, but experts say the thresholds may be too high, meaning benefits are outweighed by side effects for many people.
Nearly all men exceed the 10 per cent threshold by age 65, and all women do so by age 70 – regardless of their health.
Commonly reported side effects include headache, muscle pain and nausea, and statins can also increase the risk of developing type 2 diabetes, hepatitis, pancreatitis and vision problems or memory loss.
Research published in the Pharmaceutical Journal last year found taking a daily statin for five years after a heart attack extends your life by just four days, new research reveals.
And Dr Rita Redberg, professor at the University of California, San Francisco told CNN in January that of 100 people taking statins for five years without having had a heart attack or stroke, ‘the best estimates are that one or two people will avoid a heart attack, and none will live longer, by taking statins.’
‘Whether or not a person decides to take statins depends on what their risk of a heart attack is, how much a statin will lower this, how acceptable they find taking regular tablets, and whether they get side effects.
‘This is a very individual decision, and a doctor’s job is to explain these issues and allow a person to make the right decision for them as an individual.’
Statins, which work by lowering cholesterol so reducing the risk of heart damage due to clogged arteries, have long been a debated issue.
They are the most commonly prescribed drugs in the UK, costing the NHS millions of pounds per year, but are relatively cheap on an individual level.
The Irish study found the annual cost of statins rose in the country from €13.9million (£12.04m) in 1987 to €107.1m (£92.8m) in 2016 as a result of loosened prescribing rules.
However, many people take them before ever having any serious heart problems, which some experts say may be pointless.
The British Heart Foundation disagrees and argues all prevention is a positive move.
Speaking about the NUI Galway research, the BHF’s associate medical director, Professor Jeremy Pearson, said: ‘There’s no doubt that statins substantially reduce the likelihood of a heart attack in those who are already at risk.
‘That’s why threshold guidelines have become wider and more people than ever are now offered the drug.
‘When it comes to cost, NICE [National Institute for Health and Care Excellence, the NHS watchdog] suggests that both low and high risk individuals being prescribed statins could lead to economic benefit in the long term.’
Statins are also controversial because they can cause unpleasant side effects in patients who use them.
Commonly reported side effects include headache, muscle pain and nausea.
Statins can also increase the risk of developing type 2 diabetes, hepatitis, pancreatitis and vision problems or memory loss.
Dr Aseem Malhotra, an NHS consultant cardiologist, said that for many people ‘statins do more harm than good’
Dr Aseem Malhotra, an NHS consultant cardiologist, told MailOnline: ‘The staggering increase in patients now being “eligible” for statins is a reflection of a disturbing pharmaceutical industry influence on medical guidelines not what’s best for patients.
‘The only patients who should be offered statins using shared decision-making are those patients at very high risk of heart attacks or patients with familial hyperlipidamia, a genetic condition which affects approximately 1 in 250 people.
‘For everyone else, which is more than two thirds of those prescribed statins across the world, the evidence is very clear that statins do more harm than good.’
Professor Kausik Ray, Professor of public heath at Imperial College London, criticised the study and said prescribing guidelines should not change.
He compared taking statins to buying insurance – many people will never need it but that doesn’t make it a waste of money.
‘The guidelines are based on evidence and health economics,’ Professor Ray said.
‘These should not change. There is a misconception that doctors force patients to take medications. They do not.
‘During consultation risks benefits are discussed and depending on… how risk averse [patients] are or, often, how much they are against taking medications, most arrive at the right decision for them.
‘This is analogous to buying insurance. Many will not need to make a claim but whether someone chooses to buy it depends upon risk perception.
‘That is a different concept to denying what trials have shown where the benefits are irrefutable.’
The Irish researchers’ study was published in the British Journal of General Practice.
Source: Read Full Article