Doctors Concerned About Expanding Statin Use
In the UK, cholesterol-reducing statins are currently offered to roughly seven million people who have a 20% risk of developing cardiovascular disease within 10 years.
The National Institute for Health and Care Excellence (Nice) has called for the NHS to expand the use of statins to cover people with only a 10% risk. However, a number of leading doctors have expressed concern about this plan to advise millions more people to take cholesterol-reducing statins.
Concerned Doctors Write Letter Discouraging Expanded Statin Use
Doctor’s against the expanded use of statins have written a letter to Health Secretary Jeremy Hunt to express their concerns. The signatories, including the president of the Royal College of Physicians and a former chairman of the Royal College of General Practitioners, claim that push for increased statin use to 10% risk people is based only on studies funded by the pharmaceutical industry, which are biased towards profit.
Professor Simon Capewell, professor of clinical epidemiology at the University of Liverpool, stated: “Two decades of research has confirmed the obvious: doctors receiving drug industry funding produce recommendations favoring the industry.”
The concerned writers have cited non-industry sponsored studies that reveal an increased risk of developing diabetes in middle-aged women taking statins. Additional statin effects are: fatigue, psychiatric symptoms and erectile dysfunction.
Lastly, the letter argues that the “medicalization of millions of healthy individuals” is unjustified. Capewell also believes that Nice needs “to develop a better mechanism for controlling these conflicts of interests. The recent statin recommendations are deeply worrying, effectively condemning all middle aged adults to lifelong medications of questionable value.”
The London Cardiologist, Dr. Aseem Malhotra , agrees: “Although there is good evidence that the benefits of statins outweigh the potential harms in those with established heart disease, this is clearly not the case for healthy people.” The letter uses the examples of a doctor giving chemotherapy to a patient who didn’t have cancer or prescribing insulin to someone without diabetes to illustrate the issue.
Arguments for Expanded Statin Use
Professor Mark Baker, director of the center for clinical practice at Nice, on the other hand insisted, “Cardiovascular disease maims and kills people through coronary heart disease, peripheral arterial disease and stroke. Together, these kill one in three of us. Our proposals are intended to prevent many lives being destroyed.”
He has also assured that “these proposals and the results of this consultation are currently being reviewed prior to publication of our final recommendations next month. Our proposals are also being independently peer reviewed to ensure they are reliable and evidence-based.”
Professor Baker stressed that Nice guidance is developed by independent expert committees, meaning that none of them support the recommendations to make money for themselves but rather are providing their honest expert opinions.
He believes that this expansion “does not medicalize millions of healthy people. On the contrary, it will help prevent many from becoming ill and dying prematurely.” Professor Baker concludes: “We recognize that strong views are held by some on both sides of the argument about the best way to use statins, but our job is to reach a balanced judgment.”
Although the parties are in disagreement regarding the health benefits, both can certainly agree with Baker that “we need to act in the best interests of patients on the basis of what we know now.”
Signatories of Statin Dispute Letter
The complete list of signatories is as follows:
- Sir Richard Thompson, president of the Royal College of Physicians
- Professor Clare Gerada, former chairman of the Royal College of General Practitioners
- Professor David Haslam, GP and chairman of the National Obesity Forum
- Dr. J S Bamrah, consultant psychiatrist and medical director of Manchester Mental Health and Social Care Trust
- Dr. Malcolm Kendrick, GP and member of the British Medical Association’s General Practitioners sub-committee
- Dr. Aseem Malhotra, London Cardiologist
- Dr. Simon Poole, GP
- David Newman, assistant professor of emergency medicine and director of clinical research, Mount Sinai School of Medicine, New York
- Professor Simon Capewell, professor of clinical epidemiology, University of Liverpool.