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‘The 10% risk threshold has no credibility within the profession’

These data suggest prescribing of statins for primary prevention has changed little since NICE published the new lipid guidelines last year. Any significant increase in uptake of statins among those at lower risk would have been reflected by a major increase in the total quantity of all statins prescribed, but this has actually risen less in the past year than it did in preceding years.

The modest increase in atorvastatin 20mg and 80mg prescriptions is likely to be largely explained by a further shift away from simvastatin 40/80mg now that this switch is endorsed by the guidelines. This is underlined by the continuing fall in the amount of simvastatin prescribed. Meanwhile, concerns over rhabdomyolysis with high-dose simvastatin have also recently triggered a major sideways switch to atorvastatin, while rosuvastatin usage is actually falling.

In my experience, primary prevention with statins at the 10% 10-year cardiovascular risk threshold has no credibility among clinicians, and CCGs are even encouraging GPs to de-prescribe in low-value clinical scenarios such as this. The overall trend reflects this wider move towards de-prescribing, which is really an antidote to the overzealous prescribing of medications in guidelines driven by special-interest lobbies.

Dr Rubin Minhas is a GPSI in cardiology in Kent and adviser on the NICE 2008 lipid modification guideline