Message – Over 50 – take a statin

The risk of a heart attack or stroke is cut by a fifth in those who
have no sign of heart disease, shows research by scientists at Oxford
University.

Treatment guidelines should be reviewed in light of the findings, the
experts said, and the NHS should impose a blanket policy of
prescribing up to 20  million people statins at a potential cost of
£240 million a year.

Currently, the only people considered at high risk, those with a
one-in-five chance of having a heart attack in the next 10 years, are
given the cholesterol-lowering drugs.

Half of men aged 50 or over and almost a third of women qualify for
statin treatment. About five million people are thought to take them.

National guidelines should be amended to lower the threshold for
treatment to those with a one-in-10 risk over a decade, the experts
said.

As the majority of people in their fifties would qualify for statins
under this criteria, it would be cheaper and easier to implement a
blanket policy to save money on screening tests — which cost up to
£700 per patient — to identify them, it was argued.

The cost of statins, £1 for a month’s course, would also be offset by
the savings they would bring to the NHS in preventing costly
operations, medical procedures, rehabilitation and by freeing ward
space and places in care homes. A total of £1.3 billion is spent
annually on cardiovascular drugs alone.

The proposed statins programme would be controversial, as many believe
it is unnecessary to medicate otherwise healthy people, and it is not
clear how many would take the tablets if they were not experiencing
symptoms.

Prof Colin Baigent, co-author of the study, said: “If we want to
prevent heart attacks and strokes that come out of the blue in people
with no previous evidence of problems — and about half of such events
happen in the absence of any prior history of disease — then we have
to identify and treat people who are currently healthy but are known
to be at increased risk of developing heart disease. Such treatment
should, of course, be in addition to obvious things like encouraging
better diet, more exercise and avoidance of cigarette smoking.”

A National Institute for Health and Clinical Excellence spokesman said
the study findings will be included in the ongoing review of the
clinical guidelines on cardiovascular risk assessment and treatment.

The study analysed data from 175,000 people in 27 random trials which
compared people on statins with those on a dummy pill.

Researchers found that for every one-point reduction in levels of bad
cholesterol in the blood, there was a 21 per cent reduction in the
risk of serious events, including heart attacks, strokes or surgery
for blocked arteries among those with no symptoms of heart disease.

The risk of dying from a heart attack or stroke among those at lowest
risk was cut by 15 per cent.

For every 1,000 people in the low-risk group treated with statins for
five years there would be 11 fewer major heart attacks or strokes. “A
benefit that greatly exceeds any known hazards of statin therapy,” the
authors wrote.

Side effects of statins can include muscle aches, stomach
disturbances, and altered liver function. Patients have also reported
sleep and memory problems, depression and headaches.

There was no evidence of a rise in deaths from cancer, the authors
said, and although there was a small increased risk of a “bleeding
stroke” (a burst blood vessel in the brain) and more people were
diagnosed with diabetes in the statin group, these were outweighed by
the benefits of the treatment.

In an accompanying commentary article, Prof Shah Ebrahim from the
London School of Hygiene and Tropical Medicine, said: “The benefits of
giving statins to everyone over the age of 50 would probably save the
NHS money in the long run, owing to the savings in health care costs
from the heart attacks and strokes prevented.”

The findings were published online in The Lancet.