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As scepticism over primary prevention mounts, Caroline Price looks at new evidence that questions the increasing pressure on GPs to prescribe statins
With a new QOF indicator designed to increase the proportion of hypertensive patients prescribed a statin and Government plans to radically expand the NHS Health Checks programme, GPs look set for a big increase in the number of patients who are taking statins for primary prevention.
But a rift is opening up, with some GPs warning that the drive is over-medicalising patients.
One analysis of the major trial evidence being prepared for publication concludes that even high-risk patients taking statins only gain an average of around 14 extra days of life. Does the evidence for primary prevention need to be re-evaluated?
Dr Malcolm Kendrick, a GP in Macclesfield, Cheshire, and a high-profile statins critic, certainly thinks it does. He presented his as-yet-unpublished analysis of the evidence at a debate on primary prevention at the Pulse Live conference last month, claiming the benefits have been vastly overblown by the way trials have been conducted and reported.
?I don?t look at numbers needed to treat, relative risks, combined endpoints or effect on cardiovascular disease or coronary heart disease alone,? says Dr Kendrick, a GPC member and a former education adviser to the European Society of Cardiology. ?I look at the impact on average life expectancy - if you are going to give people medication for years and years, this is what matters.?
His analysis of data from the landmark Heart Protection Study shows that even among the high-risk patients in the study, use of statins compared to placebo resulted in 1.8% of patients living an average of just four months longer. For the other 98.2%, the statin had no impact on life expectancy.
http://www.pulsetoday.co.uk/clinica...orth-the-effort/20003174.article#.Ua8Es0C2aSp
(free registration required)
With a new QOF indicator designed to increase the proportion of hypertensive patients prescribed a statin and Government plans to radically expand the NHS Health Checks programme, GPs look set for a big increase in the number of patients who are taking statins for primary prevention.
But a rift is opening up, with some GPs warning that the drive is over-medicalising patients.
One analysis of the major trial evidence being prepared for publication concludes that even high-risk patients taking statins only gain an average of around 14 extra days of life. Does the evidence for primary prevention need to be re-evaluated?
Dr Malcolm Kendrick, a GP in Macclesfield, Cheshire, and a high-profile statins critic, certainly thinks it does. He presented his as-yet-unpublished analysis of the evidence at a debate on primary prevention at the Pulse Live conference last month, claiming the benefits have been vastly overblown by the way trials have been conducted and reported.
?I don?t look at numbers needed to treat, relative risks, combined endpoints or effect on cardiovascular disease or coronary heart disease alone,? says Dr Kendrick, a GPC member and a former education adviser to the European Society of Cardiology. ?I look at the impact on average life expectancy - if you are going to give people medication for years and years, this is what matters.?
His analysis of data from the landmark Heart Protection Study shows that even among the high-risk patients in the study, use of statins compared to placebo resulted in 1.8% of patients living an average of just four months longer. For the other 98.2%, the statin had no impact on life expectancy.
http://www.pulsetoday.co.uk/clinica...orth-the-effort/20003174.article#.Ua8Es0C2aSp
(free registration required)