GPs defy pressure to prescribe more statins
Exclusive GPs are resisting the pressure to use statins more widely since the introduction of NICE guidelines that were designed to significantly expand the use of the drugs for prevention of cardiovascular disease, a Pulse analysis of prescribing data has revealed.
The analysis shows that the number of prescriptions of statins in England has changed little since the guidelines were published last July, with only a 2% increase in statin use in the first of half of this year relative to the same period in 2014. This compares with a 3% rise the previous year, and 4% the year before.
The number of statins prescribed per 1,000 patients on GP lists has risen by just 0.9% since last year, and experts say this tiny rise reflects deep-seated doubts over the new recommendations among GPs.
The data – analysed by Pulse and the market research division of Cogora, the publisher of Pulse – show that a major change in NICE guidelines in 2014 halving the threshold for statin treatment to prevent heart disease and strokes has had little effect.
A survey by Pulse last October revealed that two-thirds of GPs were completely disregarding the guidelines and refusing to offer statins to newly eligible patients at the 10% risk level.
That result has been borne out by prescribing data. Dr Martin Brunet, GP trainer in Guildford, Surrey, and a leading member of the RCGP’s overdiagnosis and overtreatment group, said ‘neither the public nor GPs are convinced of the value in using the 10% on an individual level’.
Dr Brunet added: ‘It might make sense on a macro public health level, but the argument is very different for someone who has a 10% risk just by virtue of age.’
Dr Rubin Minhas, a GP specialist in cardiology in Kent and adviser on the NICE 2008 lipid modification guideline, said: ‘Primary prevention with statins at the 10% 10-year cardiovascular risk threshold has no credibility among clinicians.’
Dr Maureen Baker, chair of the RCGP, said that ‘discussion around the evidence base for some uses of statins and this has divided opinion’ but that GPs’ ‘main focus will always be the wellbeing of the individual patient in front of them and patients should be reassured that we will prescribe medication only when necessary and where other alternatives have been explored’.
A NICE spokesperson told Pulse: ‘If a well patient and their doctor measure the risk and decide statins are the right choice, the weight of evidence clearly shows no credible argument against their safety and clinical effectiveness in people with a 10% risk over 10 years.’