Daily statins may do ‘more harm than good’ to those less at risk
NHS recommendations state millions of people who have not suffered a heart attack or stroke should take statins as a preventative measure. However, experts writing in the British Medical Journal (BMJ) said the drugs could do more harm than good, and offer a tiny benefit for those people at low risk.
Statins work by lowering harmful cholesterol in the blood. Low-density lipoprotein (LDL) cholesterol can lead to a build-up of fatty plaque in the arteries, which can cause blockages and lead to heart disease and stroke.
The National Institute for Health and Care Excellence (Nice) recommends statins are offered to people whose ten-year risk of cardiovascular disease, including heart attack and stroke, is greater than 10 per cent. This individual risk is worked out using factors such as ethnicity and social background, and whether the person smokes or has diabetes.
But Paula Byrne and John Cullinan, from the National University of Ireland Galway, and Susan Smith, from the Royal College of Surgeons in Ireland, now argue that the benefits of statins are unclear for many people. They said research has found that statin use can be associated with a rare but serious increased risk of muscle problems, diabetes and haemorrhagic stroke.
They pointed to a study which found a 65-year-old man prescribed statins, who smokes, has high cholesterol and blood pressure, but no heart disease, could lower his absolute risk of heart disease or stroke over the next decade from 38 per cent to 29 per cent.
However, a low-risk 45-year-old woman who does not smoke, but has high cholesterol and slightly raised blood pressure, would see her risk drop from 1.4 per cent to 0.8 per cent. They said this risk reduction is so small it may not justify taking a daily pill.
The researchers also looked at the introduction of 2016 European guidelines recommending more people be given statins.
They found the proportion of over-50s in Ireland who would have been eligible for statins soared from 8 per cent in 1987 to 61 per cent. The number of people who would need to be treated to prevent one major cardiovascular event also went up substantially, from 40 people at the lowest risk in 1987 to 400 in 2016.
The researchers concluded: “Although statins are commonly prescribed, serious questions remain about their benefit and acceptability for primary prevention, particularly in patients at low risk of cardiovascular disease.”
Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “GPs are highly trained to prescribe and will only do so if they think it is in the best interests of the patient in front of them, and after a full and frank conversation about any associated risks and benefits.”