Statin of the nation: millions more could be prescribed

Death rates have been falling in recent years, but heart disease remains the biggest killer in England and Wales. In 2010, one in three people died from it. So it’s no wonder that statins, which help prevent it, are seen as something of a wonder drug.

Already seven million Britons take statins. Now new draft guidance from the NHS could see up to five million more popping the cholesterol-busting pills on a daily basis.

At the moment you are likely to have been offered statins by your doctor if you have a 20 per cent risk of developing heart disease within 10 years. The new draft guidance from the National Institute for Health and Care Excellence (Nice), which the NHS will now consult on, suggests that all those with a 10 per cent risk should be offered the drugs.

Reducing your cholesterol level, whether that’s through medication or lifestyle changes, will reduce your risk of cardiovascular disease. Professor Peter Weissberg, British Heart Foundation

The change is partly as a result of the efficacy of the drugs, which have relatively few side-effects and are already Britain’s most widely-prescribed drug, but also comes down to the fact that statins have become much cheaper, making it cost-effective for the NHS to offer them to more patients.

A study by Oxford University in 2012 found that even low-risk patients benefitted from statins. One of the researchers, Professor Rory Collins, said that up to five million people could begin taking statins if the new Nice guidance is implemented.

The drugs work by lowering the rates of low-density lipoprotein (LDL) cholesterol – so called “bad cholesterol” – in the blood. They do this by cutting production of LDL cholesterol inside the liver. High-rates of LDL cholesterol are linked to hardening and narrowing of the arteries, which can cause heart disease, heart attacks and stroke.

Widening the field of people who could be prescribed statins is a move backed by the British Heart Foundation.

“The current guidance weighed the benefits of taking a statin against what was then the considerable cost to the health service. The pragmatic decision made sure that those of highest risk benefitted,” said the organisation’s medical director, Professor Peter Weissberg.

“However, as most people who have a heart attack or stroke have average cholesterol levels and since statins are now much cheaper, it makes sense to reconsider the threshold.”

‘Drive’ to put people on statins

There are some dissenters. Dr Malcolm Kendrick, a GP in Macclesfield and author of The Great Cholesterol Con, is well-known for his anti-statin viewpoint. He wrote recently: “Working as a GP in England becomes increasingly difficult as the drive to put more and more people on statins gathers pace. Virtually every day I see a patient taking statins who is suffering a clear adverse effect.”

Known side effects include an upset stomach, headache or insomnia. More serious side effects are rare, but include kidney failure.

Others, including the British Heart Foundation, counsel that exercise is another way out of “bad cholesterol”, which is a key heart disease cause and which is reduced by statins.

Professor Weissberg said: “Reducing your cholesterol level, whether that’s through medication or lifestyle changes, will reduce your risk of cardiovascular disease.”

And Nice itself warns that taking statins should not replace living healthily in the battle against heart disease.

Professor Mark Baker, director of the centre for clinical practice at Nice, said: “People should be encouraged to address any lifestyle factors such as smoking, drinking too much or eating unhealthily. We also recommend that statins are now offered to many more people – the effectiveness of these medicines is now well proven and their cost has fallen.”