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NICE statins plan could split GP profession, warn doctors

A group of doctors, including ex-RCGP chair Professor Clare Gerada, has called for NICE to rethink its plan to lower the primary prevention threshold for statins, warning that it could cause a ‘damaging split’ within the GP profession.

Asking GPs to meet targets that they feel uncomfortable with could also trigger a loss of confidence among the public, ‘who are likely to recognise increasingly that GPs are being asked to prescribe statins despite feeling it is inappropriate’, the group of eight doctors has written in a letter to NICE and health secretary Jeremy Hunt.

The letter quotes Pulse’s own survey which found that 57% of 511 GPs oppose the plan to lower the current 10-year risk threshold for primary prevention, while only 25% support it.

The group, which also includes Sir Richard Thompson, president of the Royal College of Physicians, also warns that the move could see the ‘medicalisation’ of five million healthy individuals, which was not justified.

The letter said: ‘We urge you to withdraw the current guidance on statins for people at low risk of cardiovascular disease until all the data are made available. The potential consequences of not doing so are worrying: harm to many patients over many years, and the loss of public and professional faith in NICE as an independent assessor. Public interests need always to be put before other interests, particularly Pharma’.

However, NICE rejected the claims, saying the guidance would not medicalise healthy individuals but ‘help prevent many from becoming ill and dying prematurely.’

It said: ‘[The guidance] encourages GPs to fully explore with their patients the ways in which people can reduce their risk of cardiovascular disease, presenting all the options promoted by the draft guidance, including lifestyle changes, blood pressure control, avoidance of diabetes and cholesterol (lipid) lowering, and to allow patients to make their own decisions’.

The letter came as the MHRA reassured patients taking statins that the benefits of the drugs for primary prevention outweigh any risks from side effects. In its latest safety update bulletin, the Medicines and Healthcare Products Regulatory (MHRA) agency said trials have shown that, for people at a 10-year risk of 20% or more, statins benefit enough people to make it worth their while taking the drugs, given that they are generally well tolerated.

But the MHRA also pointed out that these trials did not investigate specific possible side effects ‘so this data is not enough to establish the safety profile of statins’.

GPs at the LMCs Conference urged NICE not to take the decision to lower the primary prevention threshold to 10% until further safety data from statin trials have been made public and fully evaluated.

LMC leaders unanimously backed emergency motion SA9 stating: ‘In light of the Cochrane review of the effectiveness of antiviral influenza treatments published in April 2014, [conference] calls upon NICE to refrain from recommending a reduction in the current treatment threshold for primary prevention of cardiovascular disease with statin therapy until this is supported by evidence deriving from complete public disclosure of all clinical trials data.’

Proposing the motion Dr Simon Poole, GPC representative for Bedfordshire and Cambridgeshire, said: ‘If NICE do recommend the decrease in the thresholds for primary prevention, will they have enough information to make that recommendation? 

‘This is a huge change in philosophy. We need a public debate on this and on the workload issues for general practice… But most of all we need to make sure NICE get it right, with all of the information.’

Readers' comments (8)

  • There is always a sixth sense. I know this isn't scientific or evidence-based but how often have you, the GP, been correct when a little alarm bell goes off for no reason. This just seems like trouble.

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  • Vinci Ho

    What NICE needs to recognise is its guidances carry both academic and medico legal responsibilities .How the guidance presents or phrases itself will have substantial impact on influencing the exercising of discretion by clinician/GP in an individual patient .
    The public(at least the media)will just view NICE as the 'authority'. Common sense tells you that it is wrong to ignore the potential side effects of statin and hence impact on an otherwise symptomless patient.
    Practically, it requires even more time and effort to educate and come to agreement with a patient of this kind individually.
    Parenting your patient is autocratic .
    A shared decision (still remember this?) is based on democratic principles...........

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  • Vinci Ho

    Statinisation must not become Stalinisation......

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  • This is Pharma driven on so many levels........I ask that GPs make a stand for the well being of us - their patients - many of whom do make the lifestyle changes. Of note in the guidance....... 'encouraging GP's to fully explore with patients the avoidance of diabetes' ....... amongst other things. - Hello!....... an adverse effect of statin medication ........is diabetes. As patients we can make informed decisions with our GP - provided we can sort the 'wheat from the chaff'.

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  • I struggle to address the patients concerns in 10 minutes let alone try to discuss why they should be taking a statin when they are otherwise relatively healthy and unfortunately are unable to undo their age. Shouldn't we be spending valuable time promoting smoking cessation, healthy eating and exercise promotion? All of which can be achieved without cost and none of which tend to give them muscle cramps or diabetes! Blimey, they might even make them feel better!

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  • Until we have full access to the trials data hidden by the pharmaceutical companies, we should hold back. Unfortunately we and our patients are not brilliant at reporting side effects...Just heard of a 92 year old given statins which gave him muscle weakness and as a result he had a fall which led to his demise. How many more stories are there like this one? What does a statin achieve for a 92year old - one extra week of life? (or, as in this case, several months less). We should all read Skrabanek again - The Death of Humane Medicine and the Rise of Coercive Healthism, or Ivan Illich's Medical Nemesis. They predicted this. In the end we have to die of something, but coercive healthism fuels the illusion that we can be made immortal if we just take the pills. All that we are doing is creating unnecessary patienthood and benefiting big pharma.

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  • Dominique Dock

    Well said Paquita. thank you

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  • It`s much easier to give a statin rather than advice and encouragement to lose weight, exercise, cut back refined CHO`s and stop smoking.

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