HEALTH

STATINS should be prescribed to all men over 65 and women over 75, a new study says.

Millions of adults should take the cholesterol-lowering pills to prevent heart attacks and strokes.

Yet some 6.3million people are not using the drugs despite the fact they are considered to be at high risk.

Researchers at Harvard estimate that if statins were given to all eligible adults in the UK, around 290,000 heart attacks and strokes would be avoided each year. Their study, published in the British Journal of General Practice, is the most accurate prediction so far of the number of adults who should be on statins.

According to guidelines issued in England by the health watchdog the National Institute for Health and Care Excellence (NICE), the pills should be offered to ‘anyone with a 10 per cent risk of having a heart attack or stroke within a decade.’

In Scotland, one in seven takes statins as record numbers are prescribed the drugs to cut their risk of a heart attack or stroke.

But doctors have warned the ‘magic pills’ are being handed out too easily. The NHS appears to be waving a white flag in the face of the obesity crisis.

Latest figures indicate that more than 715,000 people in Scotland are taking statins to lower their cholesterol. This has raised fears they are being handed out more often, with a staggering 13.4 per cent of the population on the drugs, compared to a UK rate of less than 11 per cent.

Statins are the second most commonly prescribed drugs north of the Border, behind acid reflux drug omeprazole.

The researchers used NICE recommendations to work out how many adults should take statins based on the age range, ethnicity and general health of the population.

They estimate the pills should be given to some 11.8million adults, but more than half – 6.3million – were not taking them. This suggests they are massively under-prescribed by GPs and shunned by patients worried about side effects.

The researchers estimate that each family doctor would need to offer statins to an extra 200 patients for the guidelines to be met.

Yet many GPs and academics are worried about the side effects of the pills, which include diabetes, muscle ache and memory loss.

There has been little research into ‘adverse events’ and pharmaceutical firms have blankly refused to publish details of their own trials.

Other experts, including those at NICE, insist the benefit of taking statins far outweigh any risks.

Previous research by Oxford University has found they prevent at least 80,000 heart attacks and strokes a year.

Men tend to have heart attacks and strokes earlier in life, which is why they are more likely to be prescribed them at a younger age. But if only a third of men over 60 are taking the pills at present, then this number will need to treble to meet NICE guidelines.

Professor Mark Butler, director of the centre for guidelines at NICE, said: ‘Heart disease and stroke are largely age-related, killing one in three of us and disabling many more.

‘To make progress in the battle against heart disease and stroke, we must encourage exercise, improve our diets still further, stop smoking and where appropriate offer statins to people at risk.’

Heart disease, which includes heart attacks and strokes, is the second biggest killer in the UK after cancer.

It claims 160,000 lives a year and leaves thousands of others with long-term disability or brain damage.

But Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said doctors had to respect patients’ wishes.

She added: ‘Statins have been found to be highly effective drugs at preventing cardiovascular disease by reducing cholesterol levels, and research has shown that taking them is safe. But patients should only take medication if they need to, and specifically they are at high risk of developing conditions that statins can help prevent.

‘We need to get the risk scores right. If we find that all men over 60 and all women over 75 are going to be eligible for statins with new risk scoring, regardless of any other risk factor, then it should ring alarm bells – because it is not clear that every 60-year-old man or 75-year-old woman is going to benefit from statin therapy.

‘As with any drug, taking statin medication has potential side effects and taking any medication long-term is a substantial undertaking for patients.’

The drug that saves countless lives

. Statins work by reducing the levels of cholesterol in the blood, which would otherwise block blood vessels, leading to heart attacks and strokes.

. Oxford academics say they prevent 80,000 heart attacks and strokes a year – but this could be greatly increased if they were more widely prescribed.

. Many GPs have been reluctant to prescribe in view of the side effects of statins, which include severe muscle pain that makes patients less active and more at risk of heart and vascular problems.

. Some doctors believe the safety of statins has been overplayed by drugs firms and academics with whom they have close financial ties.

. Harvard University researchers have urged patients to stick with statins despite the side effects, which they found caused up to three-quarters to ditch the medication after two years.

COMMENT

Following the research study on statins by Harvard University, NHS guidelines will suggest that nearly all men over 60 and all women over 75 should be taking them.

This would put an entire generation on pills, most of whom are otherwise healthy, to benefit a small minority of those at risk. For many, that should surely warrant serious consideration.

Some 67 million NHS prescriptions were written for statins last year. And there is no doubt that they can be a life saver for some, and prevent disability in others.

They are effective at reducing levels of ‘bad’ cholesterol, which can build up in blood vessels, leading to strokes and heart attacks, as well as damaging other organs such as the kidneys and the eyes.

Statins, which are derived from a fungus, were approved for use in 1987 and have become an established part of managing high cholesterol. But what constitutes ‘high’ is relatively arbitrary. What we have seen in recent years is ‘medication creep’ such that more and more people are being included in the guidelines.

The NHS issued its first guidance on the use of statins in January 2006. It recommended the drugs for people who showed evidence of cardiovascular disease; those whose 10-year risk of developing it was 20 per cent or higher; or, who came from high-risk groups, for example diabetics.

In 2014, the guidance was revised, lowering the threshold of risk from 20 per cent to 10 per cent. Overnight, 4.2million more people were recommended the drugs. Adults, who a few years ago, would have been judged to have cholesterol levels that could be managed by diet and exercise, were being put on statins.

There was no new evidence to support this change. In fact, there continues to be a woeful lack of clarity on whether guidance driven by England’s National Institute for Health and Care Excellence (NICE) is based on sufficient evidence.

There is an unacceptable lack of transparency in statin research. More worrying is the fact that much of this research is supported or funded by companies which have an interest in demonstrating the benefits of these drugs and downplaying the disadvantages.

When NICE revised its guidelines in 2014, it was noted that 8 of the 12 experts involved in the assessment had financial ties to statin manufacturers.

At the time, John Abramson of Harvard Medical School, a critic of statins, wrote: ‘Practically all that we think we know about the efficacy and safety of statins has been brought to us by commercial interests.’

The data involved was held as ‘proprietary secrets’.

His research, published in the British Medical Journal in 2013, suggested that healthy people with less than a 20 per cent risk of cardiovascular disease do not derive a benefit.

It should be stressed that for countless people statins are life savers, but for others the issue is not as cut and dried as NICE guidelines would have us believe. Nor is this scatter-gun approach with which they are now distributed without consequences.

Up to one in five people on statins suffer significant side effects including muscle pain, memory disturbances, cataracts and diabetes.

But of real concern about this strategy for almost universal statin prescription is that for some it becomes a substitute for changing behaviour. Why diet, drink less and exercise more when there’s a pill that will save us from the worst effects of our excesses?

We should go further and ask: is it right that the taxpayer should fund drugs for those with an indolent lifestyle who don’t want to make changes to reduce their risk of future problems?

Doesn’t this speak to a worrying attitude whereby so many refuse to take responsibility for their actions?

This isn’t to suggest that statins aren’t, for some people, the right medication, nor that people should suddenly stop taking them. But we need to be aware that the rise of statin prescriptions is one more example of the trend to reframe lifestyle challenges as medical conditions with a pharmaceutical solution.

Take obesity – one of the greatest problems the health service faces. Rather than being encouraged to eat less and exercise more, we have people being prescribed drugs that stop them absorbing the fat in their junk food instead.

Disruptive children given a label of ‘ADHD’ [attention deficit hyperactivity disorder] are put on mind-altering medicines rather than having their behaviour examined and finding a way to deal with it. So, who is driving this ‘disease mongering’? Well, the pharmaceutical industry isn’t exactly an innocent party. Identifying an aspect of everyday life that can be turned into a medical condition with a marketable treatment attached is a multi-billion-pound business.

A few years ago, shyness became known as ‘social phobia’. Millions of people, who had previously merely been uncomfortable at parties, suddenly found they had a medical condition with the result there just happened to be a drug available to treat it.

Most ordinary people think medicines are created and dispensed on a rational, objective and empirical basis. They do not understand how easy it is for Big Pharma companies to prey on their fears.

Is it a coincidence that, as the patents for certain statins begin to expire and they reach peak profitability, more and more uses are promoted? A few weeks ago, it was disclosed about the benefits of statins in kidney disease. Before that, multiple sclerosis. And on it goes; anything to keep profits up.

And what’s so depressing is that all too often the pharmaceutical industry is pushing at an open door, because it’s often easier for GPs to write a prescription than spend time advising people how to lose weight or cope with their shyness. We the public prefer to take a tablet than make tough changes to our lives.

There is one ineluctable fact: this new evidence on statins will turn even more of us into pill-poppers. We shouldn’t be convinced this is the answer.