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Half of patients on statins have ‘sub-optimal’ response to treatment

Half of patients taking statins had a ‘sub-optimal’ response to the treatment, a study has found, leading to calls for GPs to tailor statin regimens to individual patients.

Patients who didn’t achieve NICE-recommended reductions in LDL-C were more likely than those who did to suffer cardiovascular events, the researchers found.

The study, published in Heart, was carried out by primary care researchers at the University of Nottingham and looked at just over 165,400 primary care records for patients who were started on a statin between 1990 and 2016.

They found that 51% of patients had a sub-optimal response to statin therapy after two years on treatment, meaning that they hadn’t achieved a greater than 40% reduction in LDL-C levels.

When figures were adjusted for age, sub-optimal responders were 22% more likely to experience a CVD-related event, such as coronary artery disease, stroke or TIA, or peripheral vascular disease than optimal responders.

Sub-optimal responders were also 25% more likely to die of CVD-related causes.

The authors said that the findings could be explained by factors like genetics or levels of adherence to statin medication.

They said in the paper: ‘Currently, there is no management strategy in clinical practice which takes into account patient variations in LDL-C response, and no guidelines for predictive screening before commencement of statin therapy. Validated clinical decision tools which can predict cholesterol response to statins, or to non-statin drugs, with interventions to help clinicians to tailor and optimise statin treatments for individual patients are needed.’

Professor Helen Stokes-Lampard, chair of the RCGP commented: 'When we prescribe medication, we have to rely on patients to make sure that they take it, both at the recommended dose and for the duration of time that we think will benefit them most.

'There is a substantial body of research showing that statins are safe and effective drugs for most people, and can reduce the risk of heart attacks and stroke, when prescribed appropriately – but controversy remains around their widespread use and their potential side-effects.

'There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these.'

'We would encourage anyone who is on regular medication to attend their scheduled medication reviews and to raise any queries or concerns they might have. But given the widespread GP shortages and intense workload pressures that we currently have in general practice, it’s hard to know what more we can do to encourage greater compliance with medications that have been recommended in good faith.'

Professor Jamie Waterall, national lead for cardiovascular disease prevention at Public Health England, said: ’Current recommendations on statin use are based on robust and extensive evidence and it is widely accepted that the benefits of statins far outweigh any possible adverse effects.

’It’s important that statins are taken as prescribed and optimising their use in line with NICE guidance is vital to help prevent thousands of avoidable heart attacks and strokes.’

The findings come as Public Health England launched a campaign in February to increase the proportion of 40-74 year old patients receiving blood pressure and cholesterol checks to 75% by 2029. The campaign also wants to see 45% of patients at high CVD risk treated with statins by 2029 - up from the current proportion of 35%.

 

Readers' comments (9)

  • Vinci Ho

    ‘’When figures were adjusted for age, sub-optimal responders were 22% more likely to experience a CVD-related event, such as coronary artery disease, stroke or TIA, or peripheral vascular disease than optimal responders.
    Sub-optimal responders were also 25% more likely to die of CVD-related causes.’’

    So these are , in fact, figures of comparison . But I suppose the question is , ‘Is suboptimal response still better and more beneficial than not taking statin , to what extent ?’

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  • National Hopeless Service

    No mention of age? What age were these 22% of 51%? I know its unbelievable but people do die of something other than cancer when they get old.
    So does that also mean 78% of the 51% were taking statins for no purpose?

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  • Of course, there is good evidence that people who adhere to their medication (even placebo) do better than those who don't The majority).
    It seems these people are somehow different.

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  • Ivan Benett

    This finding is hardly a surprise since it perfectly exemplifies the rule of halves that exists for all long term conditions. Although there are patient factors, there are also doctor factors that all combine to lowering the effectiveness of these interventions. Cynicism and adverse press are also factors well demonstrated in these columns

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  • David Banner

    It’s fairly easy to spot the non compliant patients......if they turn up for a blood test.
    A cholesterol of 7 which dropped to 4 on a statin and is now mysteriously back to 7 doesn’t need Sherlock Holmes to figure out the reason why.
    Compliance is in the patients’ court, not ours. If they choose not to take their tablets contrary to medical advice then it is their right....and responsibility....to do so.

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  • One would have to consider the opportunity cost of the primary care clinician input needed to improve control:

    Is intensifying risk factor reduction for a large number of patients currently the most productive use of primary care clinician time?

    Or are other clinical priorities more important?

    Also, as usual, only relative risks quoted, making any judgement on the significance of the issue impossible.

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  • please-delete-this-fucking-profile-i-cant-delete-it-in-my-account-settings

    this has been widely reported in the mainstream media, with limited attention to the underlying whys - i suspect the main message that's gone out to joe public is ''perhaps statins don't work' it's too easy to bash 'the media' ..we supposedly live in a free open society where people can say what they like - i guess that comes with the freedom to write a lot of half informed crap so you can push a lot of news papers and radio air time to people who take statins. half informed doesn't mean 'well informed' but i guess it's better than being totally in the dark, just a bit of a drag we'll all be spending hours explaining it to the legions of worries 50+ patients who think they've found another reason why taking their statin is actually a very bad idea.

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  • No correction was made for alcohol consumption or smoking so the study is worthless.

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  • Una Coales. Retired NHS GP.

    I have a vested interest in solving hypercholesterolaemia without the side effects of statins as I have a genetic variant that puts me at high risk of a stroke. It was my adult daughter who came up with a non dairy diet that reduced her cholesterol from 7 to 4 without statins in 6 months. Easier said than done for me who accidentally orders a cappuccino, eats a random piece of chocolate, accepts a slice of cake, eats porridge, orders a 99 cone in Brighton, etc so my cholesterol is 8.6! Doctors are the worst patients.

    I have now worked out how to reduce lipoprotein A. All patients with high cholesterol should have their lipoprotein A checked and then referred to lipid clinic for a carotid scan if they have a family history of strokes, The carotid intima media thickness then indicates how high a risk they are for CV disease based on age group and I am at high risk on both sides.

    I researched the net looking for a way to reduce lipoprotein A. My highest was over 300 nmol/l which made me a walking time bomb for strokes. If you have a patient with super high lipoprotein A consider referring them to Professor Crook at Guys and St Thomas’ lipid clinic. He even gets referrals from Kent as there are fewer lipid consultants across the country now.

    I have reduced my lipoprotein A from 262 to 202 nmols/l with coenzyme q10 100 mg and niacin 100 mg od for 2 months and not 1000 or 2000 mg of niacin. I still have to get it below 75 nmols but am on to a winner so I thought I would share with you GPs especially as 20% of the pop have high lipoprotein A. You add it to the other box on a blood form and it goes in a yellow top tube.

    Having tried every statin and experienced lots of side effects, I am trying non rx methods that have been researched. Now I just need to start a non dairy diet and not slip. There is no profit for big pharma by telling patients to try a strictly non dairy diet for 6 months to see if it lowers their cholesterol but if it works, go for it!

    I plan to enjoy my retirement and not end up in a nursing home with a stroke!

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