Wider use of statins will have minimal benefit and could needlessly expose thousands to severe side effects, doctors warn following change in US prescription guidelines
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By Nick Collins, Science Correspondent
2:55PM GMT 14 Nov 2013
Prescribing statins to millions more healthy people would make only a minimal difference to their average lifespan but risk exposing thousands to harmful side effects, a leading doctor has claimed.
Dr Aseem Malhotra, a cardiology specialist registrar at Croydon University Hospital, said he would be “disturbed” if Britain followed America in changing prescription guidelines to widen use of statins.
There is “no doubt” that the cholesterol-lowering drugs reduce the likelihood of heart attacks and strokes in people with heart disease, he said, but the potential benefits of medicating millions more who are at low risk could be dramatically outweighed by the associated harms.
Side effects experienced by up to one in five patients include severe muscle aches, memory disturbance, sexual dysfunction, cataracts and diabetes.
New US guidelines on statins, issued on Tuesday by the American College of Cardiology and the American Heart Association, recommend that doctors should consider prescribing the drugs to all people with at least a 7.5 per cent risk of suffering a heart attack or stroke within the next decade.
US experts who drafted the new guidance said doctors had been “undertreating” patients and that the new advice would mean “more people who would benefit from statins are going to be on them”.
But the guidelines have also raised concerns among doctors in America, and in Britain where current advice that statins should be prescribed to those with a 20 per cent risk over 10 years is under review.
The National Institute of Health and Care Excellence has confirmed that the same recent clinical evidence which prompted the change in US policy will form part of its own decision, and experts believe the threshold could be lowered.
Dr Malhotra said: “I think it is very possible that this will also happen in Britain.
“One thing we have learned in the past decade is the considerable influence of a very financially powerful pharmaceutical industry over prescribing and modern medicine, and the trends suggest that this influence will have the same kind of effect over in the UK [as in America].”
Statins, which cost the NHS less than 10p per day, have become the most widely prescribed drugs in Britain and are currently used by an estimated six million people.
Some experts have claimed that all over-50s should take the drugs routinely to lower their levels of “bad” LDL cholesterol and protect against heart attacks and strokes.
Dr David Wald, a cardiologist at Queen Mary, University of London, said on Wednesday it would be “sensible” to lower the threshold on eligibility, which would be “heading towards the point where statins may eventually be offered to everyone once they reach a certain age of around 55.”
But a recent analysis published in the British Medical Journal found that even patients with a 20 per cent risk of a heart attack or stroke who were over the age of 50 may not benefit from the drugs.
“This expansion of use of statins is not good for public health,” Dr Malhotra said. “There is no doubt that for people with established heart disease the benefits outweigh the risks, but for people who do not have established heart disease this isn’t the case … I would be very disturbed if the UK were to follow suit.”
Writing in the New York Times Dr John D Abramson, who co-wrote the BMJ review, and Dr Rita F Redberg said wider use of statins “will benefit the pharmaceutical industry more than anyone else”.
“For people who have less than a 20 per cent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness,” they said.
“Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking.”