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Independents' Day

Plans put 14 million in line for statins

Plans to assess everyone from the age of 40 for cardiovascular risk will herald a new era of mass medicalisation, with almost half of those screened set to be eligible for statins.

GPs warned they could not cope with the 'phenomenal' workload created by plans for risk assessment that could put 14 million patients on lipid-lowering drugs.A new analysis of population CVD risk has found 47% of patients aged over 40 fulfil at least one of a series of eligibility criteria governing statin treatment for primary prevention.It also found 14% of patients over 40 would be diagnosed with cardiovascular disease, further ramping up the burden on workload and resources.Study leader Dr Iftikar Haq, consultant cardiologist at the Royal Victoria Infirmary in Newcastle, told the British Cardiovascular Society annual conference last week: 'Even discounting primary prevention, this is a major undertaking with large resource implications.'Guidance from the Joint British Societies and Scotland's SIGN already calls for everyone over 40 to be screened and those with a CVD risk of more than 20% over 10 years to be treated with statins.The Department of Health is hammering out details with the National Screening Committee of plans for screening at 40, 50 and 60, with NICE also about to release draft guidance on lipid modification.But GPs warned patients were becoming unnecessarily frightened by an increasingly 'fanatical' attitude towards cardiovascular prevention.Dr Peter Brindle, a Bristol GP who is advising NICE on its lipid modification guideline, warned that in his view there were serious problems in taking such an aggressive approach to statin treatment.Dr Brindle said: 'Lifestyle problems are being treated with pharmacological solutions. It's easier for the Government to put it at GPs' door.'Dr Brian Balmer, secretary of Essex LMCs, warned: 'This is getting to a fanatical stage and sends a confusing and frightening message to patients.'Dr Paul Roblin, secretary of Berkshire and Buckingham-shire LMC, added: 'As proposed, it is a phenomenal workload.'Researchers analysed data from the Scottish Health Survey 2003 including interviews with more than 8,000 individuals. Assuming all those with diabetes to be at high risk of CVD, a risk threshold of 20% meant 33% of over 40s were eligible for prevention treatments.Adding individuals with cholesterol above 7.5mmol/l increased numbers by another 6% of the population, and adding those with high blood pressure by a further 8%.

• Where are we now? CVD, page 36• Comment, back page

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