2 December 2013
Statin The Obvious?
If ever there was a “wonder drug”, then a statin would have a good chance of being called by such a name. New guidance from America suggests that even more people would benefit from taking a statin than ever before.
The significance of cholesterol in the causing of heart attacks and stroke only dawned on a suspicious medical profession gradually. Although the first statin was marketed as long ago as 1987, the uptake was very small. The company concerned, E Merck, sponsored a large study in Scandinavia which became known as “4S“. It found that people who had previously suffered a heart attack were over 40% less likely to have a further, fatal attack if they took the statin than if they did not.
This prevention was of the same sort of order as taking aspirin or stopping smoking. It was truly massive to the extent that, if a doctor is not prescribing a statin to people who have had a heart attack, they have some explaining to do.
The advice to take statins was also recommended in the course of time to people at high risk of suffering a first heart attack.
The recommendation whether or not a statin should be taken is based on risk. For many years, the cut-off point has been a 20% risk, that is a one in five chance of having a heart attack in the next ten years.
As a result of these two recommendations (previous heart attack or >20% risk) no less than 6,000,000 people in the UK are taking statins.
Experts in America have been reviewing the evidence and have issued new guidance. They advise that the level of risk where statins should be prescribed be brought right down to 7.5% risk over ten years. This figure would embrace virtually everyone over the age of 40 who smokes, has diabetes or a cholesterol level over 5.00.
This would double the number of people who would take a statin. The good news is that they are now very cheap, only about 10p a day.
This is not yet a recommendation in the United Kingdom but NICE will undoubtedly produce new guidelines in the very near future. In this field, they often take careful note of recommendations from the USA.
One final, strange thing and this is the time it takes for firm recommendations to be adopted by people working in Primary Care. Although a strong recommendation about statins was made as a direct result of the findings of 4S and guidelines were published, it took up to ten years before the figure for people who had suffered a myocardial infarction and were taking statins crept up to over 50%.