Statins offered to millions by the NHS
July 5th, 2007
A recent report in The Times on Sunday 24th June gave advance notice that the government was soon to recommend the systematic screening of all adults aged 40 – 60 years with a view to prescribing statins for those found to have a 20% chance of developing heart disease over the next 10 years. This means that some 14 million more will benefit from the use of statins on the NHS.
Dr Ralph Abraham, lead clinician for the cholesterol clinic at London Medical, believes strongly that statin use should be tailored to an assessment of global risk, with intense LDL lowering offered to patients with already documented evidence of risk factors or arterial thickening or calcification. He said: “In some ways this is good news, as many more patients at serious risk of future heart disease will get this important drug as currently only patients fortunate enough to benefit from company health screening or opportunistic tests at their pharmacy, are likely to find out that they have a high cholesterol.” The health economics argument is strong, but patients do want to know more when they have to take a drug for a silent risk for a long time. Not all cholesterol is bad and many other factors contribute to the lifetime risk an individual has for future coronary artery disease. These other factors, including direct measures of arterial thickening and calcification, have greater prognostic value than an isolated cholesterol and are important in helping patients understand their risk so allowing them to participate in the decision on medication at an appropriate level.
Targeted screening using non invasive risk factor assessment, as is routine in the Heart Protection Plan at London Medical, could ensure that the additional £560 million a year that it would cost the NHS could be directed at people in greatest need, who are more likely to be compliant with medication once they understand better the direct implications of treatment on their arteries. There is a real danger that mass medication for asymptomatic risk will be counterproductive without the monitoring and explanation that an increasingly informed public will demand.
