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Millions more need statins according to experts…but GPs fight plans
LIFE-saving statins could be prescribed to millions more people under plans to slash heart disease deaths.
Official guidance now recommends giving the cholesterol-busting drugs to eight in 10 men aged over 50 and half of all women older than 60.
The proposal by drug watchdog the National Institute for Health and Care Excellence could also see more than twice as many people over the age of 40 taking statins to lower their risk of a heart attack or stroke.
It would see the number of people eligible for the treatment more than double, from five million to 12 million.
At present, only those with a 20 per cent risk of developing cardiovascular disease within 10 years are offered statins.
Nice wants this threshold halved to include all people with a 10 per cent risk. Some experts oppose the change. They claim it will lead to the “statinisation” of Britain, accusing Nice of going “too far down the pharmacological route”.
Some GPs say many older patients will be put on statins because they are at higher risk of a heart attack or stroke simply because of their age.
In a survey of family doctors, many claimed there was insufficient evidence that the benefits of the drugs outweigh risks from side-effects.
These cause many patients to stop taking them.
Many GPs also fear the move will significantly increase workloads and make existing appointment problems worse.
In the survey by Pulse magazine, six in 10 GPs opposed the draft proposal to slash the threshold at which patients are prescribed statins.
Writing in Pulse, Dr Kathryn Griffith, a GP in York with a special interest in cardiology, said she was worried that the new guidance will automatically class too many older people as high-risk.
She said: “I am concerned that perhaps things have gone too far. All my older patients are at increased cardiovascular risk because of age rather than, for example, cholesterol levels – and they will all be over 10 per cent risk.
“In their 90s, they have passed the risk of premature heart disease. I think we should avoid offering a treatment to a group whose only risk is related to their age and for whom there is no outcome evidence. This group of patients is also the one most likely to suffer side-effects.”
The survey of 511 GPs also found that 55 per cent would not take statins themselves or recommend a relative to, based on the new risk score.
And 79 per cent predicted the change would create an increase in their workloads.
Dr Andrew Green, of the British Medical Association, said: “To do everything recommended, you would need a large number of appointments just to deal with one patient.
“General practice does not have spare appointments. Other people, who may be at higher risk, will inevitably find it harder to see their GPs.”
Professor Mark Baker, director of the Centre for Clinical Practice at Nice, said: “Drug therapy plays a key role in the management of people with high cholesterol levels.
“This is reflected in the draft guidance, which provides clear advice, based on best available research evidence.
“It is the responsibility of GPs to explain the ways people can reduce their risk of cardiovascular disease, presenting all the options.”
But Pulse editor Steve Nowottny said: “These survey findings show a majority of grass roots GPs feel the new draft guidance is a step too far.
“The fact that more than half would not take statins based on a 10 per cent risk threshold suggests doubts over the clinical evidence.
“Even among those convinced of the benefits, there are concerns over the additional, uncosted workload.
“As Nice consults on its draft guidance, it should listen to frontline GPs who will be asked to implement it.”