Statins: Effective, Affordable and Acceptable Risk-Benefit Profile (BBC News / NICE / BMJ / BMC Medicine)

Summary

According to latest guidelines from the National Institute for Health and Care Excellence (NICE), four out of ten adults in England, Wales and Northern Ireland will be eligible for statins; even though they are at relatively low risk of a heart attack or stroke. The draft guideline appeared earlier this year, and aroused some controversy among experts.

CG 181 recommends offering statins to anyone with more than a 10% 10-year risk of a cardiovascular event. The newly released official guideline will make an estimated 4.5 million extra people potentially eligible for statins. NICE believes this step could save up to 4,000 lives over three years, and prevent 8,000 strokes plus 14,000 non-fatal heart attacks.

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Reference

Gallagher, J. (2014). Statins: Millions more to get drugs in controversial plans. London: BBC Health News, July 18th 2014.

This relates to:

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Reference

Wider use of statins could cut deaths from heart disease. London: National Institute for Health and Care Excellence (NICE), July 18th 2014.

The full guideline:

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Reference

Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE Clinical Guideline CG181. London: National Institute for Health and Care Excellence (NICE), July 2014.

A good overall summary:

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Reference

‘More adults should be taking statins,’ says NICE. London: NHS Choices Behind the Headlines, July 18th 2014.

Little Evidence of Statins Causing Cognitive Decline, Dementia or Other Non-Cardiovascular Side-Effects

A thorough review has been conducted assessing the evidence about the potential non-cardiovascular harms and benefits associated with statins. This BMJ article contains a section devoted to dementia and cognition (see pages 5-6). Other side-effects considered in this evidence review include myopathy (rhabdomyolysis), diabetes, liver disorders, cataracts, venous thromboembolism, kidney disorders, pancreatitis, erectile dysfunction, COPD, cancer and fatigue.

“ …the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk”.

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Reference

Desai, CS. Martin, SS. [and] Blumenthal, RS. (2014). Non-cardiovascular effects associated with statins. British Medical Journal. July 17th 2014, 349: g3743.

Possibly also of interest:

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Reference

Macedo, AF. Taylor, FC. Casas, JP. [et al] (2014). Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. BMC Medicine. March 22nd 2014; 12: 51.

Dissenting / Questioning Voices

A recent BMJ editorial commentary offers a critique of the NICE Guidance. The authors discuss preventative mass prescription as a concept and assert that informed patient choice would (ideally) require wholesale changes to how evidence is gathered and communicated.

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Reference

Goldacre, B. [and] Smeeth, L. (2014). Mass treatment with statins. British Medical Journal (BMJ Editorial). July 23rd 2014; 349: g4745.

A much broader discussion may be found listed under Speculative Diversion: Overdiagnosis and Overtreatment.

Possibly also of interest, concerning the over-80s:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Byatt, K. (2014). Overenthusiastic stroke risk factor modification in the over-80s: are we being disingenuous to ourselves, and to our oldest patients? Evidence-Based Medicine, August 2014, Vol.19(4), pp.121-2. (Click here to view the PubMed abstract).

A related back-story concerning earlier BMJ coverage:

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Reference

Gallagher, J. (2014). BMJ ‘right’ in statins claims row. London: BBC Health News, August 2nd 2014.

A DTB editorial notes poor rates of adherence with statin prescribing in primary prevention; possibly indicating that people are not ready to become patients for the sake of the 1 in 50 chance of a potential benefit in 5 years time.

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

When 4.5 million people become patients. Drug and Therapeutics Bulletin. August 2014; 52(8): 85.

Possibly of interest:

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Reference

More over-75s should take statins, experts say. London: BBC Health News, February 1st 2019.

About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in Acute Hospitals, BBC News, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Integrated Care, National, NHS, NICE Guidelines, Northern Ireland, Person-Centred Care, Pharmacological Treatments, Practical Advice, Quick Insights, Scotland, Standards, Statistics, Stroke, Systematic Reviews, UK, Universal Interest, Wales and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

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