'Thousands More to be prescribed statins in new NICE guidelines'

BBC Breakfast television news this morning had an item about NICE's  (National Institute for Health and Care Excellence) recommendations that more people should be prescribed statins to reduce cholesterol levels in their blood.

The following is a quote as it appears on the NICE website:

'Thousands more people could be prescribed statins to help lower cholesterol levels and reduce the risk of heart attacks and strokes, under draft guidance.'

'In an update to the existing guideline on lipid modification, NICE is proposing that the threshold be halved for offering statins to people to prevent cardiovascular disease (CVD), the cause of 1 in 3 of all deaths in the UK.'

'Currently, only people with a 20 per cent or greater 10-year risk of developing CVD are offered statins. Draft guidance now recommends offering statins to people who have a 10 per cent or greater 10-year risk of developing CVD.'

'As many as 7 million people in the UK are currently believed to take statins, at an estimated annual cost of £450 million.'

'GPs should estimate the level of risk among their patients using the QRISK2 assessment tool and measurements including whether or not they smoke, their cholesterol levels, blood pressure, and body mass index. The calculator then provides a percentage risk of developing CVD in the next 10 years.'

'NICE had previously recommended the US Framingham risk tool before withdrawing advice about which risk assessment tool to use in February 2010. New evidence has suggested that QRISK2 is a more accurate CVD risk tool particularly among ethnic populations.'

'Patients with type 2 diabetes should, however, have their risk assessed using the UKPDS risk tool.'

'NICE recommends that GPs start statin treatment for the primary prevention of CVD with atorvastatin 20 mg. Patients with established CVD, type 1 diabetes or type 2 diabetes should be offered a higher strength 80mg dose of atorvastatin.'

I have been on statins since I had my heart attack in 2006. As I have mentioned in earlier posts on this blog, I had tried various forms of statins, Simvastatin for example, some of which had quite extreme side-effects, one being, when I was in hospital, being like having flu, muscle cramps,etc etc until I eventually settled on Pravastatin, which is what seems to have the least of the side effects. Reading the leaflet which is enclosed with the tablets you can see what these might be. They are, to mention only a few:

insomnia, dizziness, tiredness, headaches, sleep disturbances (surely insomnia would cover that?), muscle and joint pain, nausea, diarrhoea, wind, (I'm sure I suffer from most of these, unfortunately. I'm not so sure whether it's because of the statins though.) 

I think personally it's best to have a decent diet, low or fat-free food, for example I have always had semi-skimmed milk and use low-fat spreads instead of butter, eat plenty of fresh fruit and vegetable, give up smoking (I have never smoked so that doesn't matter to me, and cut down on alcohol intake (I drink very little so that doesn't effect me. I'd personally rather spend the money on a good book than alcohol, so I don't find that a hardship to give up.) Also, take plenty of exercise (we recently joined a gym and go swimming twice a week, and walk regularly. Not perhaps at the moment, but that's down to the poor weather, unfortunately. 

I don't personally think just putting healthy people on statins is such a good idea. If they have a risk of stroke or heart attack, maybe it's a good idea. As there was a family history of heart problems in my family then it would have been a good idea to be prescribed statins (as it happened I wasn't. Would it have prevented me having a heart attack? That, of course, is open to doubt. I was told by my doctor years ago to go on a low-fat diet, which is one reason why I went over to using semi-skimmed milk. It took some getting used to after having full-fat milk, but now I actually prefer it. Some low fat products are frankly awful, thin, tateless and now particularly nice, but there are quite  few quite nice alternatives, such as spreads, yoghurts etc etc.)

Over-50's should take statins, report recommends

The following article is posted on the Daily Telegraph website this morning, and the  report was mentioned on BBC Breakfast this morning.

 

 ' Everyone over the age of 50 should be given statins because they reduce the risk of a heart attack even in healthy people, a study has found.

Statins can reduce the chances of a heart attack or stroke even in people who are already at a low risk, Oxford University researchers find. '

 

'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.

Heart Disease Genetic link being missed

 The following news item was featured in BBC Breakfast this morning. The following is taken from the BBC News website:

Genetic link to high cholestrol is being missed

'About 100,000 patients have not been tested for a preventable form of heart disease in the UK, according to an audit of the NHS.

Familial hypercholosterolaemia is genetic; when people are diagnosed, their families should be tested.

The audit of nearly 2,500 patients by the Royal College of Physicians found that very few relations were being screened, especially in England.

The British Heart Foundation said it was frustrating and unacceptable.

Around 500 people in the UK have familial hypercholesterolaemia, which causes hight levels of “bad” cholestrol (LDL) in the blood.

If it is not treated then half of men develop heart disease before they are 55 and a third of women by the time they are 60.

Taking cholestrol-lowering drugs, statins, and living a healthier lifestyle do reduce the risk to normal levels.

Because of the genetic nature of the disease, the National Institute for Health and Clinical Excellence recommends DNA and cholestrol tests for family members, but the study says this is not happening everywhere.'


My grandparents had heart disease. I am pretty sure my grandmother (on my mother's side) had heart problems, and I am sure that she died of a heart attack. My mother had a stroke, and had angina in the later years of her life (although she never talked to us about any of her ailments. Well, parents in those days never discussed these sorts of things with their children.) She eventually died of a heart attack. This was almost exactly 30 years ago. So I know that I must have inherited my heart problems. My doctor kept an eye on my health, with regards to my family history of heart disease. So it was really no surprise when I had my heart attack in May 2006. I was told to cut down on fatty foods, which I did. I went over to drinking semi-skimmed milk and using low fat spreads and attempting, wherever possible, to always choose the lower-fat option when eating foods.