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GPs hailed for resisting over-prescription of statins

A leading US academic has praised UK GPs for their ‘widespread resistance’ to the over-prescribing of statins.

In a column in the Pharmaceutical Journal, Dr John Abramson – a Harvard University healthcare policy lecturer –  said GPs should be congratulated for not routinely adopting NICE guidance from last year that lowered the threshold of cardiovascular disease risk for statin therapy from a 20% to a 10% ten-year risk.

He referred to Pulse research published last October showing that two-thirds of GPs were disregarding NICE’s advice to offer statins to more patients.

Dr Abramson, a former family physician, has been in a long-running dispute with some UK academics.

In 2013, he and colleagues re-evaluated a 2012 meta-analysis by the Cholesterol Treatment Trialists’ (CTT) Collaboration and concluded that taking statins brought no significant reduction in mortality for people with a 10% five-year cardiovascular disease risk.

Dr Abramson published the findings in the British Medical Journal in October 2013, but they were disputed by Sir Rory Collins, a professor of medicine and epidemiology at the University of Oxford, where the CTT is based.

Professor Collins requested that the BMJ retract Dr Abramson’s analysis, but the journal ruled against this.

In his column in the Pharmaceutical Journal, Dr Abramson said: ‘British GPs are to be congratulated for their widespread resistance to unquestioned adoption of the new NICE guideline. Although the situation with statins seems singularly chaotic, the bad news is that it is not at all unique.

‘It is just the example du jour of the extent to which the primary function of medical information has become tipped toward serving commercial rather than public interest.

Readers' comments (5)

  • Azeem Majeed

    According to OECD statistics, the UK has the highest per capita use of statins in Europe.

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  • At present, it is estimated that approximately 7 million people in the UK take statins. If Nice guidance is followed the number could increase by several million. The evidence for the benefit in primary prevention – ie preventing cardiovascular disease in people who do not have any diagnosed cardiovascular disease – is weak.

    GPs,indeed have taken a very principle and pragmatic stand.Three-quarters of people having a first heart attack, for instance, have normal cholesterol levels. According to the World Health Organisation, 80% of cardiovascular disease is caused by smoking, inactivity, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people who would be much better served by simply walking more and avoiding processed food.

    Good medicine should always be evidence based and given to the right patient at the right time. Statins have an important role in patients who have an existing heart disease or have had a heart attack. Patients should be wary of these guidelines, and engage in meaningful dialogue with their doctor, before deciding whether or not to medicate. If increasing numbers of people without heart disease take statins it will be a victory for vested interests over evidence.

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  • Vinci Ho

    'I believe this is the truth according to my understanding. So you guys must follow . Any analysis against this should not be published.'
    What do we call this?
    Stalinisation instead of Statinisation, my friend.

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  • Samuel Lewis

    Dr Abramson's paper skewed itself toward the lowest risk category, and correctly stated that there was no significant reduction in mortality. CCT looked at the full 10 to 20% range and showed a significant but small improvement in mortality.

    But both analyses showed a significant reduction in heart attacks.

    The important update from NICE is that generic statins are now so cheap the NHS should lower it's rationing threshold.

    Pharma profits are not driving this.. but cost-benefit ratios are.

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  • Samuel Lewis

    "Three-quarters of people having a first heart attack, for instance, have normal cholesterol levels. According to the World Health Organisation, 80% of cardiovascular disease is caused by smoking, inactivity, an unhealthy diet, and other lifestyle factors. " - anonymous 7:15

    Can anonymous demonstrate any trials showing significant benefit from lifestyle change, dietary change or exercise ?

    most people with heart attacks do have a normal cholesterol, and do not smoke.. they are normal men over 50. Statin at £1 per month reduces their heart attack rate by at least 25% regardless of their initial cholesterol whether they smoke or not - way beyond any benefit from the 'lifestyle change' trials.

    get real.

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