Although statins have been around for more than two decades, the controversy about their increasingly widespread use rages on.
There is no doubt that cardiovascular disease is a major killer, claiming around 180,000 lives a year in the UK alone, and statins are currently offered to those with a 20% increased risk of developing the condition over the next 10 years. And now the UK’s National Institute for Health and Care Excellence is proposing to offer statins to those whose risk factor is only 10%.
By and large these ‘patients’ are healthy, and their raised risk factor is largely down to their lifestyle. Age and gender are beyond external control, but other risk factors – particularly smoking, drinking, exercise and weight – are not.
Is it really ethical to encourage people simply to pop a pill as a substitute for taking responsibility for their own health?
Leaving aside ethical considerations, it is easy to see the attraction of large-scale prophylaxis using a relatively low-cost drug to save the potential high cost of treating heart attack and stroke at some point in the future. But at what point do the risks – including liver problems, kidney failure, muscular weakness, cataracts and type 2 diabetes – outweigh the benefits, which may include reduced risk of prostate cancer and dementia, and even improved control of advanced multiple sclerosis?
According to a large, independent meta-analysis of prevention trials involving more than 80,000 patients reported in the European Journal of Preventive Cardiology, only a small number of symptomatic side-effects are actually attributable to statins. Almost all the side-effects reported in placebo-controlled randomised trials of statins occurred anyway when patients were administered placebo, the researchers found.
With even the experts failing to agree on the risk:benefit analysis, how can the average General Practitioner make an informed judgment, never mind the man or woman in the street?
It seems to be a case of paying your money and taking your pick.