A nation of pill poppers?

 
statin Around 7 million Britons take statins

A sensible step that will cut deaths and disability or a mistake that will medicalise millions?

There are starkly opposing views of proposals from the health watchdog the National Institute for health and Clinical Excellence (NICE) to dramatically increase the numbers offered statins.

They are already the most commonly prescribed medicines in the UK, which work by lowering the level of cholesterol in blood.

Around seven million people are on the tablets which cost less than 10p a day.

It is estimated they prevent around 7,000 deaths a year from heart attacks or strokes. Add to that the tens of thousands of people who are saved from disabling non-fatal attacks and you can see why health experts are keen on statins.

A generation ago cardiovascular disease was common in early middle age. As a result of statins and treatments for reducing blood pressure, the condition has been delayed by around 20 years.

That means two decades more of healthy life for millions of people.

QRISK2

The current guidance from NICE says adults with at least a 20% chance of having a heart attack or stroke in the next 10 years should be offered statins.

That is being lowered to a 10% chance of cardiovascular disease over 10 years.

So how is the risk calculated? You can work out your individual risk by going online to the QRISK2 calculator.

Input factors like your age, sex (men are at greater risk), ethnicity, blood pressure, Body Mass Index, family history, cholesterol level and so on.

It also includes your postcode: heart disease is strongly linked to poverty and deprivation so that will alter your risk too (though clearly you would expect your doctor to take account of your background, rather than just relying on your address).

My risk was well below the 10% trigger for statins. But any smug feeling was quickly despatched when I added a decade to my age.

Once you hit your sixties you can virtually guarantee that your 10-year risk will place you in the statins category no matter how healthy you are.

The effect of the proposals - which have gone out for consultation in England - would be to add millions to the numbers already on statins.

Mark Baker, from NICE, who helped draw up the guidelines said: "You'd probably need to treat about 60 people with statins for 10 years to prevent one heart attack or stroke."

That might not sound like it is worth it, but let's say you treated another six million people, that would prevent 100,000 heart attacks or strokes over a decade.

Diet & exercise

Estimating the health benefits of statins is difficult, and those figures could be an over-estimate. But you can see that - taken over an entire adult population - the potential health benefits are enormous.

So that's the argument in favour. Now the opposite view.

Putting people onto statins is akin to medicalising them for life. Rather than taking a pill to lower cholesterol, the same effect can be achieved through changing their diet and exercise levels.

Even small modifications to lifestyle - taking the stairs or getting off the bus one stop further from your destination - can make positive changes.

Offering sedentary patients a quick fix may simply store up problems for later.

"It's a very bad idea", said Dr Aseem Malhotra a London cardiologist. "Eighty per cent of cardiovascular disease is due to lifestyle and NICE should be concentrating on that aspect rather than offering pills to millions."

Dr Malhotra believes up to one in five people on statins will suffer side effects such as muscle pains, stomach pains or increased risk of diabetes.

NICE says the figure is far lower and serious problems with statins are rare. NHS Choices says "statins are generally well tolerated and most people will not experience any side effects." It lists the range of possible adverse reactions.

Ultimately it will be up to patients to decide, following consultation with their GP. One likely option for many will be to try statins and see whether they trigger any ill-effects.

Statins are saving lives and preventing disability every day. So they are a powerful tool in promoting good health. But people will need to consider carefully before deciding to take a daily pill for decades to come.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
    +5

    Comment number 28.

    Who is behind advice that NICE have taken on this?

    We need to be absolutely certain that this is not a lobbying scandal in the making, and that the people who have been advising NICE are not just those with a vested interest in selling Statins to the NHS, but have looked at this from all perspectives.

    Getting people to change their diet and do more exercise is a much preferred solution

  • rate this
    -1

    Comment number 27.

    @23 Low Carb doesn't focus on any specific food group, only limit carbs(processed sugar in foods, Chemical preservatives and foods low on the glycemic index. Not quite sure what single Mom's pushing prams has anything to do with it?? The biggest issue with low carb diets, is people do not really know what it is do they??

  • rate this
    +5

    Comment number 26.

    Its frightening and I really wonder where NICE are coming from. There are several serious side effects to statins and there is no real evidence that they have a significant effect on endpoint mortality rates. If you have really high cholesterol - over around 7.0mmol/l there may be an argument but for moderate to high levels, diet and exercise is a much better way forward.

  • rate this
    +2

    Comment number 25.

    The benefits are stressed but there is little mention of side effects, and I know from personal experience that the side effects can be bad. I also know others who have suffered. I would ask for a more balanced NICE judgement.

  • rate this
    +1

    Comment number 24.

    Death is part of life. We're all going to go sometime, better to go from a heart attack rather than a long, drawn-out disease.

  • rate this
    +8

    Comment number 23.

    14. Fishermans_Enemy

    There are lots of chubby people in Sweden. ANd single mums pushing prams

    A mixed diet with small portions is the answer, and regular activity and exercise.

    Focusing on single food groups doesn't work for most people.

  • rate this
    +30

    Comment number 22.

    I often feel like rather than a health service we have a drug dispensing service.

    In this way tax payers can help private companies make millions.

  • rate this
    +4

    Comment number 21.

    Baby boomers in early middle age are also much more active than their parents were. Are we relying on Big Data to establish whether the improvement in their health is due to lifestyle or pharmaceuticals?

    My own datapoint, age 55: Entering my data for a year ago, I got 12.5%. Entering today's data, I got 5.7%. The only difference is more fruit, veg and exercise keeping my blood pressure down.

  • rate this
    +33

    Comment number 20.

    One thing to worry about 'broadband' medication with statins is that many people taking them will then feel 'bulletproof' and not improve their diet or take up exercise. Worst case scenario is them taking the pills and their diet getting worse! Side effects are rare. Well, they'll become a lot more common if half the population is on it. Only medicate people who need it.

  • rate this
    +7

    Comment number 19.

    Does the same "making people patients" apply to Type2 Diabetes as well?

    I am beginning to think that doctors (they get paid more for T2D patients), charities (DiabetesUK) and drug firms all benefit. Often the "patient" doesn't. There is still too much poor practise e.g. in measuring blood pressure for me to have much faith in the medical profession. It needs an independent review.

  • rate this
    +4

    Comment number 18.

    Statins are cheap, low profit margin drugs, big pharma need millions of us taking them to make any decent return.
    Question is, who in HMG, NICE or whatever are connected to the drug companies? Do the companies fund political parties?
    And before you start taking statins, do some research.
    There's much nasty stuff written about them, eg it's not easy/advisable to stop taking them once you start.

  • rate this
    +2

    Comment number 17.

    It's up to GPs to ensure that Statins, and other drugs, are used wisely.

  • rate this
    +7

    Comment number 16.

    I have high cholesterol however I have a low BMI and am practically vegetarian, go the gymn etc. So have been told it is familial. I have not been offered statins as I do not have enough risk factors to give me enough points. However I do not think i would accept them even if offered due to possible side effects.

  • rate this
    +11

    Comment number 15.

    I've refused to use statins. I had 2 different ones which each caused side effects. Then I did some research and decided against using them. The GP will have to forgo my part of his profit.

  • rate this
    -1

    Comment number 14.

    A Low Carb Diet and not a Low Fat diet is key here, just look at Sweden who advocate this diet. I am also living proof, my Cholesterol was high and i was over weight with high blood pressure, Since low carb i am well on the way to a healthy weight and my High cholesterol is now normal along with my blood sugars and pressure. We are getting our diets all wrong.

  • rate this
    +30

    Comment number 13.

    My eye surgeon says statins should be banned because of the side effects. I was on them in my 60's and felt as though I was already 100 so I stopped. So did the side effects & I am enjoying life again. I am not alone in my scepticism of their benefits except for people with arterial disease but am not qualified to comment on the health/ life/ well being analysis, just my impression.

  • rate this
    +2

    Comment number 12.

    gawd can you still get them,I haven't popped a pill in years.
    I liked those shaped like a heart ,they were really trippy

  • rate this
    +2

    Comment number 11.

    changing your diet can help drinking the plant sterols can help but statins offer a cheap effective method to reduce the chances of heart disease and strokes my family has a history of early deaths from heart disease i'm in my mid 40s healthy exercise excellent diet yet I have tested for cholesterol at 7.5 im now on statins I don't want to drop dead like granddad at 56

  • rate this
    +17

    Comment number 10.

    All medication has side effects. Statins are a whole of life pill - you can't really stop them. Surely better to regulate diet and exercise than bolster the profits of the likes of Pfizer or Eli-Lilley. Eventually we'll have the 'I'm not going to die pill'. We all have to go sometime?

  • rate this
    +6

    Comment number 9.

    Plant sterols are effective and don't cause muscle wasteage, which is the last thing the elderly need.

    I take sterols already at the age of 44 and I won't be going on statins in 20 years time.

 

Page 17 of 18

 

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