500,000 at-risk Scots to be given heart drugs

Under the plan, set to be rolled out over the next five years, more than a fifth of women in that age group will also be advised to take the medicines, called statins, which are used to lower cholesterol levels in those deemed to be at high risk of cardiovascular disease (CVD).

About 100,000 people in Scotland take statins, but under the plans a further 500,000 people will be offered the drugs.

It is hoped the range of guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN) could prevent 7,200 deaths and 27,000 "cardiovascular events" - such as heart attacks and strokes - in the next five years.

However, some experts have expressed concern about such "mass medication", especially as statins are not without risks and possible side effects including headaches, abdominal pain and, in rare cases, severe muscle inflammation.

But a number of the medics who helped compile the guidelines felt they should have gone further, setting tougher targets for cutting cholesterol, with one resigning from the SIGN committee as a result.

Under the recommendations everyone over 40 in Scotland will be assessed to see if they are at risk of CVD at least every five years. A new assessment tool has been developed which takes into account family history of CVD, smoking and levels of deprivation which is linked to higher risks.

Anyone found to have a 20 per cent or higher risk of having a heart attack or stroke in the following ten years will be offered lifestyle advice and statins. This will mean giving drugs to people with no symptoms, but whose medical history means they could face problems.

The guidelines, which also include advice on the best treatment of people already suffering from CVD, will cost the NHS 78 million a year.

But SIGN experts said money would be saved elsewhere, with fewer days spent in hospital if illness is avoided. Dr Jim Grant, chairman of the guideline development group, said: "It is for the Executive and health boards to say how these guidelines are best implemented. The cost is significant, but it is small compared to the total cost of healthcare in Scotland."

The guidelines were welcomed by doctors and charities. But Dr Mike Knapton, from the British Heart Foundation, said statins were not the only solution. "I, like a lot of others, am concerned about medicating huge numbers of people," he said.

"While I am convinced that the evidence is there that statins work and are safe, I am also convinced that prevention is better than anything else. That means making sure people eat healthily, stop smoking, lose weight and reduce their risk of heart disease in those ways."

Professor Tom Sanders, nutrition director for charity Heart UK, said he had concerns about giving statins to those under the age of 55 unless there was a high risk of CVD. "Statins are not a substitute for a healthy lifestyle. They are useful in people at high risk, but as a population you could reduce the risk by up to 80 per cent with a life-long better diet, more exercise and stopping smoking. Statins should really be a last resort."

Dr David Haslam, from the National Obesity Forum, broadly welcomed the extension of statins to more patients.

But he said that the people must not assume taking a pill means they do not have to take other measures to reduce their risk of heart disease and stroke.

"There is always the danger that people will think it is either one thing or the other and believe that once you are on pills you can do what you like," he said.

Naveed Sattar, professor of metabolic medicine at Glasgow University, said statins had a very good safety record and there was excellent evidence that they did reduce the risk of CVD.

"What these guidelines are doing is lowering the threshold for who we treat with statins," he said. "But they are still very much targeted at those who are at risk and not at everyone."

He said that evidence suggested statins are 1,000 times safer than aspirin. "It is very difficult to reduce cholesterol by even 10 per cent with changes to your diet alone. But with statins it can fall by 30, 40 or 50 per cent."

Threshold for medicine lowered

NEW guidelines mean anyone with a 20 per cent risk of suffering coronary heart disease (CHD) or a stroke within ten years will be offered statins.

This lowers the threshold from the previous recommendation of treatment for those with a 30 per cent risk of CHD alone.

Using an assessment tool called ASSIGN, your GP will measure risks.

Anyone who has had a heart attack, stroke, angina or heart failure, or who has diabetes, is automatically classed as being at high risk, along with those with a family history of familial hypercholesterolaemia.

But the doctor will also consider other factors. Older people and men are more at risk, as are smokers and the overweight.

People with a family history of heart disease and stroke and those with high blood pressure and cholesterol also face greater risks.

The new assessment also looks at where you live, as evidence shows deprivation increases heart dangers.