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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.’

Analysis: GPs defy push to widen statin use

The 10% risk threshold has no credibility within the profession’

 

 

Readers' comments (13)

  • I would promote JBS3 guidelines because the evidence is there and it is good research. Since high intensity statins such as Atorvastatin have become off -patient this intervention is reasonable.

    If there was a 10% probability of winning the lottery over 10 years, then if you could count you would buy one everyday but here we are talking about CVAs.

    Clinical Pharmacist

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  • But the effect of statins is not going to reduce strokes by 10% - make it probably 1-2% and this delays rather than prevents in all probability. There is however a 10% risk of side effects. I agree statins should be offered but to go back to your lottery analogy, yes, a statin is like a free lottery ticket but if someone hit you over the head with a baseball bat each time your bought a lottery ticket, how many would you buy?

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  • Feel free to offer statins to all and sundry a beautiful piece of marketing.The bottom line for statins is you gain 1 day of " life" for every year of treatment in primary prevention and perhaps a little bit more in secondary prevention , so after 30 years of treatment .... you gained a whopping 2 and a bit months... cheers mate thanks for all those side effects. Anyone think they might give them a miss? As 8.52 I think Dr M Kendrick states so eloquently in his blog this is " Delay-ative medicine not preventative medicine". The reason for NICE recommending offering statins at a lower threshold is an economic one due to the affordability of treatment but does not adequately take into account the harms.

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  • I do not believe that prescribing a statin would in itself reduce the risk of a CVA by 10% in 10 years. There are other parameters that come into play; but if we are discussing delay-active medication then consider the management of hypertension to reduce the risk of a CVA, very few clinicians would disagree that is is not an appropriate route to take.

    Pharmacists notoriously remain impervious to marketing from drug companies.

    The associated side-effects of myopathy, myositis and rhabdomyolysis is considered to be rare- it is a duty- of- care to explain risk, NNT, NNH and NNO.

    I may get attacked when with a man with a baseball bat when trying to buy a ticket but then again it is more likely I would die in a RTA.

    Pharmacist @ 8.14

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  • Anonymous | Pharmacist 29 Oct 2015 8:14am

    If the tablets were completely safe and never give side effects I would be inclined to agree with you.

    As it stands, I see plenty of statin side effects, and many more non specific aches/pains which statins are potentially culpable for.

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  • The 10% target does not take into account the hassle to patients and primary care alike. The benefit is also questionably. Thank you NICE for, yet again, demonstrating how little you know about primary care. Off with their heads.

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  • What concerns me that ; ''patient in front of me has become inured to primary care prevention messages and JSB3 toolkit is an interactive tool"" and proactively aids in changing patient behaviour.
    In secondary care prevention the patient 'journey' may have become so traumatic that the conversation took place was too late and the patient has lost faith in the NHS.
    I do not believe that any guidance should dictate professional judgement ...we need to have more informed discussions with our patients.

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  • Pharmacist 0927
    NNT
    "none were helped (lives saved)"
    "1 in 104 were helped (preventing heart attack"
    "1 in 154 were helped (preventing stroke)
    NNH
    "1 in 100 were harmed (develop diabetes)"
    "1in 10 were harmed (muscle damage)"
    Source "theNNT.com"

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  • Ivan Benett

    'Defy' is a bit overstating it, don't you think?. How about 'GPs use NICE guidance to form a balanced judgement in the best interest of their patients'? Remember NICE guidelines aren't mandating the prescribing of statins. In fact if you actually look at the guideline it is clear that lifestyle changes should be encouraged first, and then review risk.
    The exceptions are existing CVD, Type1 diabetes and CKD.
    If QRISK2 still 10% in 10years, have a discussion and make a shared decision, taking into account potential benefit, possible harm, cost and individual autonomy. In fact, just like every other clinical decision we make with our patients.
    This necessarily means that some will choose to decline the offer of medication, and that's OK so long as patients are given the opportunity to make an informed decision.
    Rubbishing the NICE advice just because you don't like it is as idiotic and following it slavishly.
    I know Pulse have a vested interest in polarising views, but really medicine is much more subtle than tabloid headlines can convey. Especially evidence based medicine.
    See the excellently well written and crafted NICE Quality Statements on this issue. Some of Britain's top clinical brains have gone in to writing them!

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  • Assessments re risk benefit analysis cannot be accurately made, or indeed made with ethical integrity, until all those advocating expanded use of statins - (including -and especially those involved in creating "guidelines) -identify all, - or exclude pharma industry "Conflicts of Interest."

    Surely Study 329 "re-visited" ( BMJ. September 2015) identifies professional naivety regarding Pharma marketing masquerading as Medicine?

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