Doctors putting patients of f statins

Prescriptions drop for those most at risk as research suggests GPS ignore NHS drive

PATIENTS most at risk of heart attacks and strokes are still not being prescribed statins despite a drive by the NHS to put more people on the drugs, a study reveals today.

Analysis of nearly 250 GP practices shows that despite the advice to doctors to put millions more people on statins, the proportion of those with the worst outlook taking the cholesterol-lowering drugs has dropped.

In 2014, watchdogs dramatically lowered the threshold for prescribing statins, effectively encouraging doctors to make them available to more patients.

But the latest research suggests patients and GPS have been deterred from following the guidance amid continuing controversy over the drugs.

Last night, experts said that in the privacy of the consulting room, family doctors often pointed out to a patient that they may gain only a small benefit.

“We talk to patients about the risks and benefits on an individual basis,” said Dr Sammuel Finnikin, a GP and Birmingham University academic who led the research. “The majority of patients who take statins get no benefit – they think about the side-effects and make their decision.”

The study also indicated just one in four patients given statins had been subjected to the proper test.

Critics of statins question their effectiveness and point out that any benefit can be outweighed by side effects that include aching joints, dizziness and nausea. However, statins reduce death from heart disease by around 28 per cent, according to a study published in Circulation last month, while a Lancet report last year found fears of sideeffects to be exaggerated.

It found that if 10,000 patients were treated with the drug for more than five years, only 200, or 2 per cent, would experience negative side-effects.

The latest study, published in the British Journal of General Practice, found that since the National Institute of Health and Care Excellence (Nice) halved the risk threshold in 2014, the rate of prescriptions to those at high risk decreased, but it increased among those at lesser risk.

From 2012 people were eligible for statins if doctors believed they had a 20 per cent or higher chance of cardiovascular disease in the next decade, based on their cholesterol levels, exercise, blood pressure and lifestyle factors. Then, in 2014, the threshold was lowered to 10 per cent, partly because of the increasing affordability of the drug.

The research led by Birmingham University looked at data from 1.4 million patients aged over 40 across 248 practices in England and Wales between 2000 and 2015.

Among those with a risk score recorded before 2014, more than a third – 36.7 per cent – of high-risk patients were prescribed statins. After the Nice guidance was issued, calling for a more widespread uptake, the figure dropped sharply, to 33.1 per cent.

The researchers said most patients who had a risk score calculated were not offered a statin in the subsequent two months – even those deemed to be

high risk. They also found that there could be “significant over-treatment” of statin therapy among patients who have less than a 10 per cent chance of developing cardiovascular disease within 10 years.

The study found there had been “increased focus on the adverse effects of statins … which may have influenced both the clinicians’ decision to prescribe and the patients’ decision to accept treatment.”

It follows a warning by the Royal College of GPS (RCGP) in August that the cholesterol-lowering drug was being “needlessly doled out to millions”, mainly on the basis of their age.

Helen Stokes-lampard, a British medical academic and chairman of the Royal College of GPS, said: “This study emphasises the importance of calculating an accurate risk score which can then help healthcare professionals have an honest discussion with their patients about the benefits and risks which are unique to them.

“As with any drug, taking statin medication has potential side-effects, and taking any medication long-term is a substantial undertaking for patients

‘Many don’t want to take statins once they have all the facts – and GPS will respect patient choice’

who need to be monitored by healthcare professionals.

“Many don’t want to take statins once they have learned all the facts – and GPS will respect patient choice.”

New prescriptions of statins peaked in 2006 following the drug’s patent running out, therefore making it more affordable, in 2003.