GPs should consider statins 'in everyone over 55'
By Pat Anderson
GPs should offer cholesterol and blood pressure lowering treatment to prevent cardiovascular events on the basis of age alone, rather than using multiple risk factors, according to UK researchers.
The researchers at the Barts and the London School of Medicine and Dentistry found using age to guide statin and hypertensive therapy would avoid the need for tests and medical examinations, and would be just as effective at preventing heart attacks and strokes as multifactorial risk scoring.
The paper - published this week in the online journal PLoS ONE by Professor Nicholas Wald and colleagues – reports the results of a simulation involving data from 500,000 people.
They found age screening using a cut-off of 55 years detected 86% of all cardiovascular disease events with a 24% false-positive rate. Screening using age alongside risk factors such as blood pressure and serum cholesterol detected 86% of events with a 21% false-positive rate.
Professor Wald told Pulse: 'We have shown that almost all the risk is accounted for by age alone. Age is by far the most important risk factor as the risk of heart attack and stroke doubles every seven and a half years.'
'We're not recommending cardiovascular screening, just saying let the entry ticket to an offer of preventive treatment be much simpler and based on age alone,' he said.
He said it would be 'sensible and in the public interest' to screen for cardiovascular disease using age alone and that although an age cut-off of 55 was given as an example in the paper, in practice the age cut-off could be set higher or lower based on judgment of efficacy, serious side effects and cost of treatment.
Offering treatment with statins and blood pressure lowering agents would not 'indicate a failure of public health but would be part of public health providing added benefit to smoking cessation, exercise and dietary change', he explained.
He added patients with side-effects such as muscle cramps would need to go to their GP to discuss changing or stopping medication: 'Statins are not risk-free but the incidence of serious adverse events is low.'
Dr Terry McCormack, a GP in Whitby and a council member of the Primary Care Cardiovascular Society, commented: 'This paper is presenting a hypothesis which is interesting and worthy of debate.'
He said it would be interesting to repeat the study taking into account the different risks faced by men and women. He said GPs would be unlikely to change their behaviour as a result of the study.