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Egenis · News

Statins

28.08.2007

Story

Heart disease medication is being massively over-prescribed with thousands of people being wrongly told that they are in danger of developing cardiovascular problems, according to a study.

A British Medical Journal study says that there are flaws in the traditional method of assessing risk of heart disease and suggests that current estimates of the number of people in danger of the disease are 1.5 million too high. The BMJ study proposes a new measure which also takes social deprivation, genetic factors and weight into account, reducing estimates. As a result, it has concluded that 3.2 million adults under the age of 75 are at risk of developing cardiovascular illnesses compared with the 4.7 million previously estimated. A separate study by the Healthcare Commission says the number of people reported as having heart failure issues was 140,000 fewer than expected.

Using the new equation, the researchers estimated that the number of people at risk may have been over-predicted by as much as 35 per cent. Consequently, many patients have been prescribed anti-cholesterol drugs, called statins, unnecessarily, inflating the annual £2 billion bill to the NHS.

Egenis researcher Hannah Farrimond commented:

‘Statins are cholesterol lowering drugs that lower the risk of heart disease. They lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. The most common side effects are feeling tired and in a small proportion of people they can affect liver function. There has been concern amongst the medical profession that they are being encouraged to over-prescribe for some time. The National Institute of Clinical Excellence (NICE) has issued draft guidelines that everyone with a 20 percent or more risk of cardio vascular disease over the next ten years should be offered statins. If accepted, these guidelines will be adopted by doctors across the country.

Doctors and others involved in health research have several concerns about a plan to introduce widespread statin use. Firstly, they are quite costly to NHS although this is offset to some extent by the gains of preventing heart disease and secondly, they can cause side effects in some individuals. It is also not clear whether lowering cholesterol in the wider population with statins will dramatically cut heart disease rates as the relationship between statin use and decreased heart disease is very modest. It has been suggested that having two glasses of red wine a day is better at preventing heart attacks than statins’

The researchers tracked 1.28 million healthy men and women aged between 35 and 74 over 12 years to April this year and used GP records from 318 general practices. The higher estimates of heart disease were derived from the traditional way of calculating risk using the ‘Framingham’ equation, which involves a score based on smoking, blood pressure and “good” and “bad” cholesterol, along with age and sex, based on the Framingham American cohort who were followed from the 50’s to the 70’s. Although the new equation uses similar variables, they are calculated from a different, British population who may be less at risk.

Dr Farrimond explained that the study had been useful. ‘ It highlights the difficulties of calculating any individual’s personal risk using a general equation based on a large number of people. The new equation itself can be criticized as it includes individuals already treated for risk factors such as high blood pressure or lifestyle interventions. Although it may describe the population risk in the UK better than the original risk calculations, it may not reflect an individual’s true risk if they have not been treated already.’

Dr Farrimond has been working on a project concerned with the family history of heart disease at Egenis: ‘The new equation includes family history as one of the risk factors. NICE is also recommending that clinicians use family history as well as other factors to assess who is at ‘high risk’ of heart disease. Doing this as part of a national policy for primary prevention of heart disease would certainly help identify those who are at greater risk due to hereditary factors such as genetics and similar lifestyles and environment amongst certain families. However, as with all things in life, there are potential pitfalls as well. Initial research has shown that family history can sometimes be problematic area for patients to discuss with health professionals. GPs and nurses often have a different understanding of family history than the patients. There are also ethical and legal issues around recording and using third party information. Including family history will increase the number of people on statins still further as more people will meet the ‘high risk’ criteria.’

‘There may be the need for further training on identifying and communicating about family histories for GP’s and nurses. It would also be more effective if the recording of family history was standardised, as at present, each practice often devises their own methods and uses different criteria’

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