UK: Statin drugs for all adults?
Proposed guidelines for cholesterol-lowering statins
Proposed new guidelines in the UK recommend cholesterol-lowering statins to all adults if “the person is happy to take a statin”.
Normally, people with a 10% or higher risk of having a heart attack in the next 10 years are eligible for statins in the UK.
But now, draft guidelines proposed by the National Institute for Health and Care Excellence (NICE) say that doctors may prescribe statins to anyone over the age of 18, even if their risk of heart disease falls below the 10% threshold.
The draft guidelines are currently in consultation, with an expected final publication date of 17 May 2023.
Why the change?
It’s reportedly in response to the British Heart Foundation’s announcement that since the arrival of covid, there have been over 30,000 excess deaths linked to heart attacks and strokes.
UK’s chief medical officer Sir Chris Whitty claimed there was ‘little doubt’ that reduced uptake of statins or blood pressure pills helped explain the excess deaths from heart disease during the pandemic.
However, Professors Tom Jefferson and Carl Heneghan pointed out that there was no “evidence that lipid regulating and antihypertensive drugs were prescribed less in the last three years based on the NHS’s data.”
Medicating healthy people?
If the draft guidelines are finalised, it will mean that millions of healthy people become “patients” overnight, simply because NICE lowered the criteria for prescribing statins.
Leading doctors have argued against giving statins to healthy people at low risk of heart disease because the benefits are unlikely to outweigh the harms.
Half of people stop taking statins within a year of commencing — 62% say it’s due to muscle aches and pains, often limiting their physical activity and ability to exercise (a preventative to heart disease).
But NICE does not agree that statins cause a high percentage of muscle problems, deferring to a large study published in the Lancet showing the rate of muscle pain in statin users was essentially the same as people on placebo.
The study however, has serious flaws because the majority (78%) of statin trials analysed, either did not specifically question people about muscle problems during the trial, or the data was not known.
As Peter Doshi, Associate Professor at the University of Maryland School of Pharmacy said, “Inadequate data collection can render the results ambiguous or meaningless.”
High cholesterol in heart disease?
NICE has also stated that “high cholesterol is a significant risk factor” for heart disease, but this ignores an abundance of evidence to the contrary.
My colleagues and I recently published a systematic review and meta-analysis in JAMA Internal Medicine, demonstrating no consistent relationship between heart disease and lowering LDL-cholesterol with statins.
LDL-cholesterol is merely a surrogate marker, and its causative role in the development of heart disease is consistently being questioned by eminent cardiologists and researchers.
In 2018, a comprehensive review of the literature published in Expert Review of Clinical Pharmacology, showed that there was no correlation between LDL-cholesterol and heart disease.
The authors of that review wrote that the ‘cholesterol theory’ had been kept alive all these years “by individuals who have ignored the results from trials with negative outcomes and [who’ve used] deceptive statistics.”
In fact, Rita Redberg, cardiologist and editor-in-chief of JAMA Internal Medicine once said to me that “Cholesterol is just a lab number. Who cares about lowering cholesterol unless it actually translates into a benefit to patients?”
This is not the first time that NICE has come under fire.
In 2014, there was uproar when the agency slashed the ten-year risk threshold from 20% down to 10%, making 4.5 million extra people eligible for statin treatment.
Despite claiming it would prevent up to 28,000 heart attacks and 16,000 strokes each year, retrospectively, it had virtually no benefit.
Notably, British journalist Lucy Johnson published an explosive investigation which revealed that 8 out of 12 committee members had financial ties to companies that made statins or next generation cholesterol-lowering drugs.
Déjà vu anyone?
For anyone familiar with my turbulent history working as a TV presenter for the Australian Broadcasting Corporation (ABC TV), the push to prescribe statins to virtually “everyone” will sound familiar.
In 2013, I produced a documentary for ABC TV, which questioned the over-prescription of statins.
I pointed out that statins were first intended for people at high risk of having a heart attack. But then over the years, the guidelines would progressively expand the eligibility criteria to new populations.
Some suggested that statins could be handed out as condiments in burger outlets to “neutralise” the harmful effects of fast food. Others thought that putting statins in the water supply was a good idea.
Following the documentary’s broadcast, it generated so much outrage from statin manufacturers and industry groups, that the ABC capitulated to the pressure and censored the programs, including a fully referenced webpage dedicated to extended interviews and scientific papers.
Looking back now at how the pandemic has unfolded, it feels like déjà vu.
Journalists and scientists are still being censored by vested interests, drug companies continue to influence medical guidelines, and profitable medicines are at the forefront of health policy.
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