A Statin A Day Keeps The Doctor Away
8 CommentsBy Ed Silverman // May 28th, 2008 // 1:55 pm
And can ring a few registers, too. In the UK, more than a million people will be put on statins to lower their cholesterol level and prevent heart attacks, under new guidelines published today. Docs are urged to trawl the records of patients aged 40 and over to find people with a one in five chance of having a heart attack or stroke and call them in for advice and drugs, The Telegraph reports.
Four million people already take statins, mostly after heart attacks. But the UK’s National Institute for Health and Clinical Excellence wants healthy people deemed at high risk of an attack or a stroke within 10 years to have preventive drugs as well, the paper writes. That would put 1.5 million more on meds and should prevent an extra 15,000 heart attacks, strokes and new cases of angina each year.
NICE recommends checking records of everyone aged between 40 and 75 to flag those at high risk and call them in for lifestyle advice and consider prescribing 40mg of generic Zocor. Putting healthy people on meds for the rest of their lives may be controversial, but some docs say the move is worthwhile.
Tim Marshall, a public health specialist and member of the NICE guideline development group, says that “cardiovascular disease is the leading cause of death in England and Wales, accounting for 124,000 deaths – one in three – in 2005. For every one fatality there are at least two people who have a major non-fatal cardiovascular event. The guideline suggests an achievable and realistic strategy for identifying those people at high risk.”
Peter Weissberg of the British Heart Foundation gave a mixed reaction: “The BHF welcomes NICE’s endorsement that cardiovascular risk factors should be identified and adapted for each patient. However, relying on patients to attend surgeries for assessment will fail to reach many from socially deprived and ethnically diverse communities who are most at risk. This issue will have to be addressed if the Government’s vascular risk assessment programme is to achieve its aims.
“The BHF is disappointed that Nice ducked the issue of providing guidance on target levels of cholesterol for people who don’t yet have heart disease but are at high risk.”
Paul
Interesting that this “good medicine” is being recommended now that most statins are generic. When they were branded and still patent-protected, everyone was saying that it is bad medicine to have such broad risk reduction strategies.
So, it is all about medicine at the cheapest cost afterall!
ellie
My concern is that this “good medicine” will stay “good” throughout life.
When I think of the various “good” things that have been offered in the
past which turned out to be “bad” with deadly side affects such as “THE PILL”, I begin to wonder.
Each generation brings new ideas and hope–May we hope that the Pharma
folks begin to concentrate on really helping people throughout the world
rather than just making loads of money?
M Helm, MD
Typically, in order to benefit from long-term medication use, adherence to the daily use is important. With statins, the magic number for adherence seems to be 75-80%. In other words, if you miss more than one in four or five doses, you may get no long-term benefit.
For patients with real perceived problems, it is difficult enough to achieve that level of adherence. I wonder how patients will take to the idea that they in fact need this treatment even though they were previously unaware. I wonder if patients will perceive the decision to treat differently as this would seem to be based as much on policy as on a physician interaction. I wonder how the NHS will monitor this experience.
On the other hand, sometimes just alerting individuals to their risk factors - which they may or may not have understood can be preventable - leads to behavior change and risk modification. I have seen this happen in a pilot program with couselling delivered in the workplace by pharmacists. Medication was not prescribed, but on follow-up (I think it was 9 months) LDL, BP and risk factors for the group were improved. Some did seek their physician’s help, and some were started on meds (not only statins).
When it comes to guidelines, we know that there are many instances where there is clear support for a specific set of treatments in specific conditions. These treatments are often not delivered to a large percentage of the relevant patients. This failure may have much to do with human fallability of physicians and patients alike.
Paul, I don’t know the specific rationale for this policy, but you must remember that when it comes to a cost-benefit analysis - and almost all public policy ultimately does - COST is relevant. If the costs are now 1/100 of the previous costs, the benefits shown do not have to be of as great a magnitude. Economics and marketing are not the same discipline.
Additionally, it is not as though the use of these medications was restricted before - there are 4 million already on treatment. The estimate is to add another 1.5 million. This seems to me more an effort to “close the gap” between what is known and what is practiced.
Justice in Michigan
Small point re: adherence - the last study I showed suggested only 40-50% were still taking statins a year after rx’d. This is generally explained by a combination of not “seeing” whatever benefit, some degree of AEs (mainly myalgias), and human frailty (or instinct), I guess.
M Helm, MD
J.I.M.
The data on adherence to asthma controller medications are even worse than what you quoted. Different category, I know. I don’t think adverse drug events explain the problem. As far a instinct goes, most folks have an instinct to breathe… I have no answers here.
I think PhRMA has no answers either, or there would be greater emphasis on expanding the pie (through adherence) rather than chasing market shares of “new prescriptions.” How many times do you see DTC advertising that simply reminds the patient to take their medication daily?
Stinky
I think that cholesterol Rx adherence is more like 20%, one of the lowest categories in pharma.
Justice in Michigan
Doc Helm - Re: reminder ads, every month I get a letter presented as though it’s from my pharmacist to remind me to refill an rx. In fact, in small print it says it comes from the manufacturer. Cute. Use it in class.
Lilli
Doctors do not monitor and report adverse side effects with statins.Statins intract with other medications and doctors are also not reporting this issue. Congress must provide protection from medications, instead of protecting the pharmaceutical companies. Serious adverse side effects from statins are not diagnosed and this is causing serious harmful rhbadomoylysis and peripheral neuropathy. If not treated promptly this conditions leads to death. How do we collect statistics of these serious events if doctors are not reporting the side effects? Pharma and the medical profession and healthcare industries must be made to be accountable and if not should be disciplined.