Should everyone over 50 take statins?
[url=http://www.dailymail.co.uk/health/article-2194892/All-50s-statins-regardless-health-history-says-Oxford-professor.html]'All over-50s should take statins regardless of their health history,' says Oxford professor | Mail Online[/url]
Statins should be given to all over-50s, regardless of their health history, because they dramatically cut the risk of heart attacks and strokes in later life, one of the UK's leading experts has said.
Currently statins are given only to high-risk patients, around eight million people, who have high cholesterol or have a risk of heart disease.
But there is 'clear evidence' that healthy people can also benefit based on their age alone, says Professor Sir Rory Collins.
He led the world's largest study to investigate statins in the prevention of cardiovascular disease which proved that cutting levels of 'bad' LDL cholesterol in the blood saved lives.
The risk of having a major vascular event such as a heart attack is cut by one-fifth for each 1.0mmol/L (millimoles per litre) fall in LDL, whether in high or low risk patients.
But current guidelines on their use - and misguided safety fears about muscle pain and memory loss - are restricting the range of people who can take them, he said.
'At 50 you should be considering it and whether you should be taking them at an earlier age is an open question' he said.
'If you start treatment earlier and continue for longer the benefits will be much greater, you're not trying to unfur the arteries, you're preventing them from furring in the first place' he said.
Prof Collins, who was giving a keynote lecture at the European Cardiology Congress in Munich, said evidence from 130,000 patients taking statins in trials show they are safe.
Yet drug safety watchdogs here and in the US have insisted on flagging up relatively minor side effects which are putting patients off the drugs, he said.
These include memory loss, depression, sexual difficulties and depression, while recent research suggests cataracts and diabetes may be more common in patients taking statins.
Trial data shows only one significant side effect, myopathy or muscle pain, which affects one in 10,000 patients, said Prof Collins.
He said: 'We need to look properly at the safety of statins. The reality is that these drugs are remarkably safe, but the problem is that high risk patients are getting the message that these drugs have side effects.'
Prof Collins, 57, went to his GP a fortnight ago to ask about taking statins despite a relatively low cholesterol level, and was dismayed to learn she could not get high risk patients to take them because of fears about side effects.
Research earlier this year co-ordinated by the Clinical Trial Service Unit Oxford University, where Prof Collins is co-director, reviewed findings from 27 statin trials involving 175,000 people, some of whom were at low risk of heart problems.
The drugs cut the risk of heart attacks, strokes and operations to unblock arteries by one third or more.
The benefits were gained no matter what level of cholesterol patients started out with. Healthier people who were given statins also had lower overall death rates than those who were given a placebo.
It concluded the positives greatly exceeded any side-effects from taking the drugs.
More than eight million adults are already taking statins, but it is estimated that routine use by the over 50s would lead to 10,000 fewer heart attacks and strokes a year, including 2,000 fewer deaths in the UK.
The small cost of the drugs - as low as £16 a year - would be outweighed by NHS savings due to the reduced number of heart attacks and strokes.
At present, statins are restricted to those with at least a 20 per cent risk of having a heart attack or stroke over the next five years.
But, said Prof Collins, trial data shows very low risk groups can benefit where individuals have just a five to 10 per cent chance of heart disease, and even lower.
He said there did not appear to be a threshold at which the drugs didn't work and the longer they were taken, the greater the benefit.
'We need to review the guidelines and the current thresholds should go,' said Prof Collins, who claimed medical tests such as liver function were also unnecessary.
Professor Peter Weissberg, medical director of the British Heart Foundation, said: 'The issue is where do you set the threshold between low, normal and high risk.
'The current arbitrary threshold was decided by cost but now statins are off patent (and much cheaper) it may be appropriate to see if there are benefits for more people - the threshold is a bit too high,' he added.
Conventional wisdom gone mad?