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I would not take statins myself at the 10% risk threshold and I won’t encourage my patients to take them either

Giving statins at the 10% threshold risks doing more harm than good, argues Dr Nick Chiappe

I would not take statins myself this risk threshold, because the risk to benefit ratio is not as certain as the ‘experts’ say - and minimal for the individual.

For example, for an approximately 3% chance of benefit to me, assuming statins were 30% effective at preventing stroke and heart attack, I would have to make myself a patient, rather than a healthy 50-year-old.  

I would have to take tablets every day,  I would have to pay a minimum of £50 of my own money per year in prescription charges, have at least annual checks with my doctor and have a significant risk of side effects.

As a GP of 22 years’ experience, I find it almost impossible to believe the very low rates quoted by Collins et al[1] for side effects.  At least 10% of my patients stop them for side effects, particularly muscle and joint pains, which clearly disappear on stopping the pills and restart on rechallenge.

I would rather get/stay slim and exercise regularly, which would be likely to produce similar long-term benefits, with added fitness self-confidence and enjoyment of life. If I smoked or drunk too much, I would be better being helped to reduce these than take pills. 

Obviously the risk-benefit ratio improves as risks increase. I would consider treatment at 20% risk and do strongly recommend my patients consider it along with lifestyle changes.

Treatment of risk rather than illness means for many patients we are breaking the ‘above all do no harm’ instructions of Osler, replacing it with a more modern aphorism ‘don’t worry about harming individuals if there is net benefit to society’.

Dr Nick Chiappe is a GP partner in Plymouth Devon

1. Cholesterol Treatment Trialist Collaborators et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380:581-90

Readers' comments (2)

  • The advice from NICE is too simplistic, possibly aimed at increasing statin sales, and as a practice we are not suggesting we follow the 10% rule. Personally I discuss with patients their risk and compare it to the "average" age/sex risk that the Q risk calculator usefully shows. If the average risk was 2% and my risk 10% then assuming this is due to he lipids contribution of my calculation then maybe there is a discussion to be had. BUT if my risk was 25% and average for age/sex 27% then really not sure I would treat myself as my risk is already better than average for my age.

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  • David Bush

    I'm not really a conspiracy theorist. I don't believe the advice has been given purely to drive pharma sales. I think it has been given because the politicians feel it will save the NHS a lot of cash 10 years or so into the future. Of course it won't, because if we all live longer we'll get something else.

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