New statins guidance could make extra 15m people eligible in England

[Northerner]

As many as 15 million more people could be eligible for cholesterol-lowering statins to protect them against heart attacks and strokes, according to draft guidelines for the NHS in England.

The National Institute for Health and Care Excellence says the scope for those who can be considered for the drugs should be widened dramatically – in what would be the single biggest change in a decade – to save thousands more lives.

Cardiovascular disease is the leading cause of death worldwide, killing nearly 18 million people a year. In England, high cholesterol causes 7% of deaths and affects up to 60% of adults.

Existing Nice guidance, covering about 10 million people in England, states that those with a 10% or higher risk over 10 years of a cardiovascular event, such as a heart attack or stroke, should be offered statins.

New statins guidance could make extra 15m people eligible in England

Guidance for NHS says extending cholesterol-lowering treatment could save thousands more lives

www.theguardian.com

Not for me, thanks 🙂

 

[Deleted member 21371]

Each to their own.
I'm more than happy to be taking them.

 

[nonethewiser]

They should add it to water supply.

Running for cover.

 

[Eddy Edson]

The NICE PR: https://www.nice.org.uk/news/articl...r-risk-of-heart-attacks-and-strokes-says-nice

Amd the proposed updated guidance: https://www.nice.org.uk/guidance/gid-ng10178/documents/draft-guideline

FWIW, I'm not sure how coherent this is.

Eg: NICE points out that statin uptake amongst those who should be on them according to the current guidance is less than 50%, and the biggest public health impact would come from increasing that level.

With National audit data suggesting that 56% of people with a risk score of 20% or more take statins, compared with less than 50% for people with scores between 10% and 20%, the committee agreed that focusing on increasing uptake among people with the highest risk of CVD events would have more impact. For this reason, the draft guidance says people with a lower than 10% risk can be considered for statin therapy while people at a higher risk should continue to be offered statins. NICE uses ‘consider’ recommendations when there is a closer balance between benefits and harms of an intervention that could be used.

It says it doesn't know why the uptake is so low - what combination of GP's not prescribing correctly, patient resistance, whatever - but then it doesn't include this question in its list of important research topics.

With that lack of visibility, it can have no real handle on which GPs and which sub-10% risk patients might choose to take advantage of the expanded "consideration" criteria.

Some people will get the benefit of the low-as-possible-for-as-long-as-possible approach to lipid management, now emerging as a widely-held expert view - but probably only a very small minority, is my guess, given that GP's generally don't keep up with this kind of thing unless they have to, and many of them seem to be less than excellent at communicating lipid-control benefits even to high risk groups.

 

[everydayupsanddowns]

With that lack of visibility, it can have no real handle on which GPs and which sub-10% risk patients might choose to take advantage of the expanded "consideration" criteria.

10% does seem to be a bit of a tipping point in the conversation, at least it was with the diabetes-specialist clinicians I spoke to.

 

[bulkbiker]

Or maybe not...

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2753.2011.01767.x

 

[bulkbiker]

Not for me, thanks 🙂

Me neither...

 

[Deleted member 21371]

Or maybe not...

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2753.2011.01767.x

That's a blast from the past, a study over a decade ago, got anything relevant to the studies today that we're talking about?
(We're in 2023 now, not 2011)

 

[bulkbiker]

That's a blast from the past, a study over a decade ago, got anything relevant to the studies today that we're talking about?
(We're in 2023 now, not 2011)

Still just as valid an observation? If the "dangers" of cholesterol are not present why bother with drugs...

 

[Deleted member 21371]

Still just as valid an observation? If the "dangers" of cholesterol are not present why bother with drugs...

View attachment 23738

Because we'd rather go on results from another 12 years of research, and keep an open mind, than trawl through history for out of date opinions that validate our own bias.
As you say "updated" for 2011, "current" in 2011.
Personally, I live in 2023 now.

 

[bulkbiker]

Because we'd rather go on results from another 12 years of research, and keep an open mind, than trawl through history for out of date opinions that validate our own bias.

Oddly though most of the pro statin research is from pre 2004...

I'd rather keep an open mind that there's quite a lot of money behind promoting the most profitable drug ever invented ( for the moment)... especially when it has multiple side effects and minimal benefits.

 

[Deleted member 21371]

Oddly though most of the pro statin research is from pre 2004...

I'd rather keep an open mind that there's quite a lot of money behind promoting the most profitable drug ever invented ( for the moment)... especially when it has multiple side effects and minimal benefits.

Well, there's always a conspiracy theory somewhere to buy into....

 

[nonethewiser]

Being discussed right now on R2 if anyone wants to listen.

 

[Deleted member 21371]

Being discussed right now on R2 if anyone wants to listen.

Just listening to it now.

 

[mikeyB]

I used to take statins for years without any problem. I don’t take them anymore because I don’t need them, my cholesterol levels are perfect. If that changes, I wouldn’t mind taking them again.

 

[bulkbiker]

This doesn't sound like such a great advert for them though..

Effects of statins on mitochondrial pathways - PubMed

Statins are a family of drugs that are used for treating hyperlipidaemia with a recognized capacity to prevent cardiovascular disease events. They inhibit β-hydroxy β-methylglutaryl-coenzyme A reductase, i.e. the rate-limiting enzyme in mevalonate pathway, reduce endogenous cholesterol...

pubmed.ncbi.nlm.nih.gov

 

[Deleted member 21371]

This doesn't sound like such a great advert for them though..

Effects of statins on mitochondrial pathways - PubMed

Statins are a family of drugs that are used for treating hyperlipidaemia with a recognized capacity to prevent cardiovascular disease events. They inhibit β-hydroxy β-methylglutaryl-coenzyme A reductase, i.e. the rate-limiting enzyme in mevalonate pathway, reduce endogenous cholesterol...

pubmed.ncbi.nlm.nih.gov

View attachment 23762

As the conclusion says, it's all if's and maybe's, apart from the author's only actual claim
"The beneficial effects of statin treatment are not questionable".

 

[bulkbiker]

As the conclusion says, it's all if's and maybe's, apart from the author's only actual claim
"The beneficial effects of statin treatment are not questionable".

And yet...

Benefits of statins may have been overstated – new study

Cholesterol-lowering statins are one of the world’s most commonly used medicines. They were first approved for people with a high risk of cardiovascular disease in 1987. By 2020, global sales were estimated to have approached US$1 trillion (£764 billion).

www.rcsi.com

 

[Deleted member 21371]

And yet...

Benefits of statins may have been overstated – new study

Cholesterol-lowering statins are one of the world’s most commonly used medicines. They were first approved for people with a high risk of cardiovascular disease in 1987. By 2020, global sales were estimated to have approached US$1 trillion (£764 billion).

www.rcsi.com

Another if and maybe?
And you need to actually understand statistics before you trawl the the internet.
That article is utterly meaningless, both relatively and absolutely.
It's just a collection of cute buzzwords, designed to pull in the anti's.

The internet is full of them, you could keep finding oddballs all day.

 

[bulkbiker]

Another if and maybe?
And you need to actually understand statistics before you trawl the the internet.
That article is utterly meaningless, both relatively and absolutely.
It's just a collection of cute buzzwords, designed to pull in the anti's.

The internet is full of them, you could keep finding oddballs all day.

Everything in the field of human nutrition and health is made up of "ifs and maybes" there are very few, if any, absolute proofs.. there is no "the science".

I'd suggest if you think that there are it's you who need to read the papers a bit more carefully.

I'm simply representing some alternative views to the "mainstream" so people are better informed.