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Independents' Day

200,000 patients 'may have quit statins' following negative media coverage

Hundreds of thousands of patients may have stopped taking statins because of widespread media coverage of controversy over the drugs’ risks and benefits, a study in the BMJ has claimed.

The UK researchers estimated that an extra 200,000 stopped statin therapy in the six months after a period of intense media coverage on the topic, which coincided with NICE plans to widen statin use for primary prevention in low-risk people.

They said that this could lead to around 2,000 more heart attacks and strokes within 10 years than would have been expected if the usual statin discontinuation rates had been maintained.

The team also claimed that GPs stopped giving patients a cardiovascular risk score during this period – something they said could be down to both GPs and patients being less willing to discuss risk scores and statins, because of worries about the potential side effects of statin treatment.

The authors said that, although they could not prove that the additional discontinuations were down to statins reporting, the study suggested that the debate had dented public confidence and they urged better balanced reporting.

Using data from UK GP practice records, the researchers calculated the number of people starting and stopping statins each month, over the period from January 2011 to March 2015.

They found a 19% relative increase in the proportion of people stopping statins for primary prevention – up from a rate of 0.08 to 0.09 per month – in the six months from April to October 2014, following a period of intense media reporting of statin controversies.

During that period - at the end of 2013 through to 2014 - there was widespread media coverage of research papers in the BMJ claiming statin side effects are worse than has been reported from randomised trials, as well as opposition to NICE plans to advise that millions more low-risk people should be on statins.

After the six-month post-exposure period, from October 2014 onwards, discontinuation rates went back to normal.

Similarly, there was a transient 25% relative increase in the proportion who stopped statins among those taking them for secondary prevention – up from about 0.06 a month to 0.07.

The researchers said the increase in patients stopping statins for both primary and secondary prevention would equate to an excess of 218,971 patients stopping statins across the whole of the UK. Assuming two-thirds of people would have restarted therapy, this could mean 2,173 excess cardiovascular events within 10 years, the team said.

Co-author Professor Liam Smeeth, a part-time GP in North London who also heads up the department of non-communicable diseases epidemiology at the London School of Hygiene and Tropical Medicine, said the study raised concern that reporting of the debate on statins ‘may have given disproportionate weight to a minority view about possible side effects, denting public confidence in a drug which most scientists and health professionals believe to be a safe and effective option against heart disease for the vast majority of patients’.

But Dr Bill Beeby, deputy chair of the GPC clinical prescribing subcommittee, said that the controversy over the risk and benefit ‘is far from resolved, with large numbers of clinical trials remaining unpublished concealing much of the negative data surrounding their use’ and that ‘doctors who offer the benefits still lack all of the data to quantify the risks to individual patients’.

He said: ‘We need to ask patients for their opinion about the information they need to come to a reasonable judgement not influenced by tabloid journalism. Then we may be able to present it in a way that doctors can consistently explain and patients can properly assess what it means for them.’

BMJ 2016; available online 28 June

The statins controversy

Controversy around statins reached fever pitch at the end of 2013 when NICE announced plans to expand statin use in people at relatively low risk for cardiovascular disease – meaning potentially millions more people taking the drugs.

At the time many GP experts vociferously opposed the NICE proposal, with dissent among doctors picked up in the national press. The GPC and RCGP warned that the plans were unjustified by the evidence and would create unsustainable workload for GPs. The LMC conference in 2014 called on NICE to postpone their decision until they had full access to trials data, following concerns raised about the true extent of side effects.  

Professor Clare Gerada, then chair of the RCGP, along with other leading doctors including Professor Richard Thompson, former president of the Royal College of Physicians, warned NICE that they risked ‘splitting the profession’ over the decision.

NICE has pushed ahead with the move, but data uncovered by Pulse has since suggested that GPs are reluctant to follow the guidance.

And controversy over the true benefits and harms of statins has not gone away, with experts continuing to call for drugs companies to disclose all their trials data to the public - not just a single research team - so that an independent study can be carried out.

Readers' comments (13)

  • Well said, Bill Beeby!I think BMJ's chief editor, Fiona Godlee's ' shocking' comment to lack of access to the data is very telling...
    It vindicates the LMCs conference unanimous motion passed, in May 2014 the calling for NICE(threshold for starting treatment to prevent cardiovascular disease to be halved from a 20% risk of developing cardiovascular disease over 10 years to a 10% risk) to recommend such changes only on the basis of a full disclosure of trial data. The decision to increase use of statins is based on trial data only a few chosen people have seen. We need to demand greater transparency about the research on these drugs.

    ' the public debate on statins through media has clearly had a very positive impact on many levels. It's encouraged GPs to take a more critical look at the statin data. Most GPs and patients can now better weigh up benefit and risk and make prescribing decisions based upon individual patient preferences and values as opposed to an ethically suspect financially incentivised blanket prescription to a healthy population.' Instead of converting millions of people into statin users, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise, and avoiding smoking.Remember,the researchers estimate, that for every 100 people without known heart disease who take statins for five years, 98 would see no benefit, and only one or two would avoid a heart attack that they might not have otherwise.

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  • And which national daily newspaper carried this story on its front page this morning?

    ...The Daily Mail.

    Oh, the irony.

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  • Peter Swinyard

    Not often that I become a conspiracy theorist - but is Big Pharma trying to pull the wool over prescribers' eyes in denying us reports of lack of effectiveness or harms? We really are flying blind here and I think Kailash is totally right - as often - in saying that the number needed to treat in primary prevention may be disproportionate to the harms done in medicalising healthy people - and probably damaging their life assurance risk! they are not clean drugs without side effects... There is no argument against their use in secondary prevention, however.

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  • In fact, Statins could do more harm than good (if any) - the resaerch papers are based on certain NUMBER of people .... could be squewed - (statistics??? LIE LIE & Complete lie) - they went to show only that the statins may prevent clot dislogement and not prevent forming plaques etc... Vitamin C strengthens the basement memberne of the fine arteries and making sure one has sufficient Vit C to do this important normal function .... this won't make the commercial giants happy! (prescribers may not be aware of this)

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  • The Daily Mail and the irony: Look at todays daily mail headline. lol.

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  • Statins are so efficients that 15 days (my expertise) is enough to lower to normal the total cholesterol, but as well HDL and LDL. Price very low! less than 1p a tablet...
    So the Pharmaceutic Industry is working on a specific lowering LDL drug. Of course very expensive!!
    So is the late attacks on Statins Lobbying (???) to be able to sell another much more lucrative drug...but not yet on the market because worst side effects!!!
    I ask a question: why not take avantage of a low dose of aspirin and statin?? Unbeatable in primary prevention!!!

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  • You are right
    Peter swinyard and kendrick my favourite nnt and analyst
    Like my autism professor in Canada and the great lancet and BMJ
    All support the argument for statin
    Do I take it ?

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  • The best GP could to Dorset and joins the practices earning over £250 per patient
    Or join a CCG and secure retirement money or your practice paying contracts
    Forget statins
    Look at the money

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  • Cobblers

    In the Times today;

    "GPs should not automatically trust medical journals which “have an axe to grind”, said Peter Weissberg, medical director of the BHF".

    No irony intended? Hypocrite.

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  • Anonymous 11:56
    Er.., I think you'll find you have massively misinterpreted if you think Kendrick supports statin prescribing or taking?!!!
    (BTW some serious grammatical and spelling errors in this thread, system does provide a spell check)

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