Statins

[Gob]

Doctors have been told to offer cholesterol-lowering statins to millions more people in a massive and controversial expansion in prescribing.

Four in 10 adults in England, Wales and Northern Ireland are now eligible for statins, even though many are at low risk of a heart attack or stroke.

The medicines regulator, NICE, says it will save lives.

There has been vocal opposition to the plans, and doctors' leaders said they had no confidence in the decision.

But all sides of the debate say people who are already taking statins should continue to take their medication.

Cardiovascular disease - which includes heart attacks and strokes - is the UK's biggest killer.

It claims 180,000 lives a year and is behind one in three deaths.

Statins reduce the build-up of fatty-plaques that lead to blockages in blood vessels.

They are already given to high-risk patients who have a one in five chance of a heart attack in the next decade.

Medicines regulator the National Institute of Health and Care Excellence (NICE) is now telling doctors to give statins to low-risk patients with a one in 10 chance of a heart attack in the next decade if measures to improve lifestyle fail.

Effectively every healthy man over 60 - or woman over 65 - could be offered statins.

Those with high cholesterol, smokers, the obese or with a strong family history of heart problems could be offered the drugs at an even younger age.

NICE said it had conducted the "best and most complete review of evidence in this field" and concluded that giving the drugs to low-risk patients would have benefits.

About 13 million people are currently suitable for statins, although only seven million choose to have them prescribed.

The NHS estimates the drugs save 21,000 lives over three years.

Changing the guidelines is estimated to make 4.5 million more people suitable for statins, although only half are likely to choose to be prescribed them.

NICE believes the measure will save up to 4,000 lives - as well as preventing 8,000 strokes and 14,000 non-fatal heart attacks - over three years.

Prof Mark Baker, the director of the centre for clinical practice at NICE, told the BBC: "Prevention is better than cure.

"One of the mainstays of modern medicine is to use treatments to prevent bad things happening in the future, it's why we use vaccines and immunisation to prevent infectious disease, it's why we drugs to lower blood pressure to prevent heart attacks, strokes, and kidneys disease and it's why we're using statins now."

However, there guidelines have opened a schism in the medical profession.

There is a continuing argument about side-effects with NICE arguing there are barely any while other doctors say it is a massive problem.

There have been accusations, denied by NICE, of people drawing up the guidance being influenced by the pharmaceutical industry, wider arguments about "medicalising" a nation and encouraging patients to take pills rather than change their unhealthy lifestyle.

The British Medical Association's General Practitioner's committee said: "There is insufficient evidence of significant overall benefit to low-risk individuals to allow GPs to have confidence in the recommendation."

It said the measure would "distort health spending priorities and disadvantage other patients".

It would cost £52m to give statins to all 4.5 million people who became eligible. But due to the falling costs of the drugs, the statins bill for the NHS would still be lower than in 2012.

The guidelines immediately come into place in England, devolved institutions in Northern Ireland and Wales need to sign-off the guidelines separately, but have historically followed NICE rulings.

The 10% risk threshold is comparable to other European countries.
'Lifestyle focus'

Prof Peter Weissberg, the medical director at the British Heart Foundation, said: "Doctors will now be able to offer a statin to people at a lower risk, but their prescription is not mandated.

"Just as important is the emphasis on trying lifestyle changes before considering treatments with drugs."

The president of the Academy of Medical Sciences, Prof Sir John Tooke, said: "Whether or not someone takes drugs to diminish their risk is a matter of personal choice, but it must be informed by accurate information on the balance of risk and benefit in their particular case.

"The weight of evidence suggests statins are effective, affordable and have an acceptable risk-benefit profile."

[rubato]

I have heard of fairly serious long-term problems with statins and questions about their effectiveness in reducing deaths from HA. The balance might be different for a 40-50 year old vs a 70 year old. Someone starting them at 40 has a longer course during which effects might occur.

I'd have to look into it but if it were [major lifestyle change] vs [statins] I'd take the former.

A colleague whose 30-something husband had a bad family history of early death from heart disease (almost no male relatives over 50) and very high cholesterol was able to control it with changes in diet. Medicine needs "somatic coaching" as a treatment option.

yrs,
rubato

[Big RR]

The medicines are there for those who cannot control their lipid profile by diet and exercise. For a variety of reasons (mostly genetics), my doctor wants me to keep my cholesterol very low, and it could not come down low enough with changing my lifestyle. I've had a total cholesterol of 100-110, and HDL of 55-60 for the last 10-15 years due to Lipitor and diet/exercise. It's a tradeoff, but I'm only 5 years younger than when my mother died, and 3 years younger than when she developed coronary problems; her brother died right around my age and her father was about 10 years younger. I have periodic blood work to keep an eye on things, and no problems so far (for most people who do develop problems, they come pretty early, but who knows what happens longterm.

[Daisy]

Cookie has Familial hypercholesterolaemia. Inherited from his mum, he has been on statins since his mid 30's. No amount of lifestyle changes can adjust his cholesterol levels, prior to his treatment his levels were four to six times the normal levels. Even with Rosuvastatin he still sometimes has double the level.

It's estimated that 1 in 500 people have the faulty gene and only 1-5% of those have been properly diagnosed with genetic testing. I think rather than blanket dispensing statins the resources would be better spent on testing for people really at risk.

[TPFKA@W]

Cookie has Familial hypercholesterolaemia. Inherited from his mum, he has been on statins since his mid 30's. No amount of lifestyle changes can adjust his cholesterol levels, prior to his treatment his levels were four to six times the normal levels. Even with Rosuvastatin he still sometimes has double the level.

It's estimated that 1 in 500 people have the faulty gene and only 1-5% of those have been properly diagnosed with genetic testing. I think rather than blanket dispensing statins the resources would be better spent on testing for people really at risk.

Preach it sister. Honestly this has to be brought to you by the fine makerofsandgetsrichoffsellingthem statins. If people would get up off their lazy asses and move they would not need this stuff. With few exceptions most problems are lifestyle induced. Husband's pacemaker issue is genetic, younger brother who is fit a a fiddle, (career military) will need one too. BTW he survived, is safely at home now. He did quit breathing during the procedure and had to be intubated.

[Big RR]

I agree, medication should never be given before lifestyle changes are tried and prove to be ineffective.

[Gob]

Ha!! Easy for some to say, do you know what those "lifestyle changes" involve?

NO FUCKING CHEESE!!!!!!!

[BoSoxGal]

I am someone whose gene profile involves having essentially healthy (high for me, but well within the healthy range) cholesterol levels despite being significantly overweight and out of shape (I've let my body go to shit these past few years with living to work rather than working to live).

My new D.O. and I had a long discussion about the various medications I'll need and the various complications I'll face if I don't get my body back into shape; I'm choosing major lifestyle changes over medication, but it is challenging, that's for certain! (I can't have as much cheese - but it makes the cheese I can have very special to me! )

The primary change for me is making the choice to trade in high salary, super high stress for lower salary, largely low stress job. I'm lucky because without kids and others to support, and without being wed to any other golden handcuffs, I can make that choice. I just decided I'd rather live a long time and see a lot of stuff - even if it's from my room at the old folks' boarding home - than to check out in the next 20 years due to illness.

I'm very much against people taking long-term meds unless it is absolutely necessary; I believe people like Daisy's honey and @w's are legitimately in need of certain interventions and that's when medicine's a miracle - I take a couple of daily medicines without which my life would be intolerable from illness that can't be fixed by lifestyle change, and I'm willing to bear the side effects of taking those.

But I think it's a very bad thing that the trends in advertising and minimizing consulting time with doctors has led to so many people just taking pills long term and not really knowing how relatively easily taking meds could be avoided.

[Gob]

I LIKE CHEEESE!!!!!!!! IN FACT I FUCKING LOVE CHEESE!!!!!!

[BoSoxGal]

[Sue U]

I LIKE CHEEESE!!!!!!!! IN FACT I FUCKING LOVE CHEESE!!!!!!

O. ----- M. ------ G. , I just realized:

=

Wallace <-----------------------------------------------------> Taff

[TPFKA@W]

Wow! Obviously they were born conjoined at the ears!

[Daisy]

Wow! Obviously they were born conjoined at the ears!

[Gob]

Thanks Sue TPFKA@W, and Daisy, my Monday morning chuckle.

[BoSoxGal]

Very good one, Sue!

[oldr_n_wsr]

I LIKE CHEEESE STEAK!!!!!!!! IN FACT I FUCKING LOVE CHEESESTEAK!!!!!!

Fixed that for you.

My bad cholesteral is a little high, but my good stuff is very high also, so the doc is not giving me meds yet.
BP is usually 120/70 with a pulse rate of 50-60. I do take a hypertension pill and anti anxiety pill. (and I have gone back on antabuse).
I used to make fun of the old lady next door about all the pills she had on the counter and would take every day. I'm catching up to her.
Sometimes I wonder what would happen if I just didn't take any of them?

The Little Rascals had an episode about that.

ETA
@W, glad you hubby's doing well.