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Tuesday, 2 May 2017

SHOCKING! "Heart attack danger as six million given wrong dose of statins" - The Times

The Times & Sunday Times
Tuesday May 2 2017
In today's edition
Must reads
Heart attack danger as six million given wrong dose of statins
Six million people are on the wrong dose of statins, with tens of thousands of heart attacks likely as a result, a study has found.
Chris Smyth, Health Editor

GPs have been urged not to keep people on an old prescription out of “inertia” GETTY IMAGES  

The vast majority of people on the cholesterol-lowering drugs are not on the variety or dose recommended by the latest guidance. It is a situation that must be corrected as a “public health priority”, doctors say.

GPs have been urged not to keep people on an old prescription out of “inertia”, and to do more to help people to remain on statins rather than giving up at the first sign of problems.
Patients have been asked to wait until they visit their GP about other issues before checking their dose, amid fears that overstretched doctors could not cope if millions booked appointments specifically to discuss their statins.
The National Institute for Health and Care Excellence (Nice) issued guidance three years ago recommending more potent statins, as well as saying that many more people could benefit from higher doses of drugs that now cost only 6p a day. However, concern lingers among GPs about side-effects, despite the most rigorous studies finding that they are relatively rare.

Researchers have used GPs’ records of 184,000 patients to compare what they are being prescribed with the Nice guidance. They found that in a group of those with heart disease, who are most at risk, only 6 per cent were on the recommended drug at the recommended dose. About 21 per cent were not on any statin at all.
In a second group, of those at risk of heart disease, only 15 per cent were on the recommended statin, with 38 per cent not taking a statin. The researchers estimate that this means that three million people in each of the two groups need to adjust their dose or start taking statins. “It’s a huge number,” said Kausik Ray, of Imperial College London, senior author of the paper in the journal BMJ Open. “Unless primary care identifies this issue and tries to change, they will only present to hospital either when they happen to be there for something else or when they have a [heart attack].”
Optimising the statin dose in all these people would mean “tens of thousands [of heart attacks and strokes] that you prevent with a really simple intervention”, Professor Ray added.

Dylan Steen, of the University of Cincinnati, lead author of the study, said: “Given the benefits of moving to intensive statin therapy, this should be a public health priority. In most cases the issue is simply addressed by switching one pill for an equally safe one.” He said the problem was “clinical inertia”, with doctors thinking, ‘If they’re on it and doing all right, let’s not rock the boat.’ ”
Dr Steen said that 680,000 people with heart disease not taking a statin was unacceptably high and even if they had reported side-effects, about 90 per cent could be helped to stay on the medicines.

He said that people on a statin did not need to panic, but advised: “Just make sure when you’re at your next GP appointment that you bring this up.”
Mike Knapton, associate medical director of the British Heart Foundation, agreed that the problem needed to be addressed, saying: “Guidelines move on but it’s easier to leave a patient on what they’ve previously taken. I wouldn’t say it’s malpractice or complacency. In a perfect world we would challenge the patient but the pressure on GPs makes that difficult, particularly given the millions taking statins.”
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, insisted that the Nice recommendations were “guidelines, not tramlines” and that doctors were issuing prescriptions based on individual circumstances. “Taking statins is a long-term commitment and patients may have their own views. A decision to prescribe statins should always be the result of a discussion between GP and patient,” Professor Stokes-Lampard said.