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22 June 2016

Millions of People May Be Needlessly Taking Statins Every Day

Researchers found reducing the level of 'bad' LDL
cholesterol from a 'high' to a 'moderate' level did have an
impact on heart risk.  But reducing levels from 'moderate'
to 'low' levels - roughly the level targeted by the NHS - had
no effect on patients at all
Millions of people may be needlessly taking statins every day: Study claims lowering cholesterol may NOT slash heart attack risk
by Ben Spencer, Medical Correspondent for the Daily Mail, 20 June 2016

- Study: Lowering cholesterol below a certain level doesn't cut heart risk
- Reducing level of 'bad' LDL cholesterol from a ‘high’ to a ‘moderate’ level did have an impact on heart risk, reducing heart emergencies by 13%
- But reducing levels from 'moderate' to 'low' levels - roughly the level targeted by the NHS - had no effect on patients at all


Millions of people may be needlessly taking statins every day, according to research which suggests lowering cholesterol below a certain level does nothing to reduce heart risk.

Scientists questioned the ‘blanket’ medical assumption that lowering cholesterol reduces the risk of heart attacks, strokes and other cardiovascular problems.

The researchers tracked 32,000 people with heart disease who were prescribed cholesterol-busting statins.

They found reducing the level of ‘bad’ LDL cholesterol from a ‘high’ to a ‘moderate’ level did have an impact on heart risk, reducing heart emergencies by about 13 per cent.

But reducing levels from ‘moderate’ to ‘low’ levels - the level targeted by the NHS - had no effect on patients at all.

The research, by the Clalit Research Institute in Tel Aviv, Israel, reignited an ongoing row about the benefit of prescribing statins to millions of British people.

Statins, which cost the NHS just £2 a month, are taken by an estimated 7million people in Britain who are deemed to be at risk of heart disease.

Many of these people are only prescribed the drugs as a precaution - some do not have high cholesterol and have not showed signs of any heart problems.

And the numbers taking the drugs are believed to be on the rise, since NHS watchdog NICE changed its advice in 2014 to encourage GPs to prescribe the cholesterol-busting drugs to anyone with a 10 per cent chance of having a heart attack in the next decade.

That change means 17million adults - nearly all people over the age of 40 - are now eligible to take the drugs.

Some experts say statins are priceless, saving an estimated 7,000 lives in Britain every year.

But many GPs and patients are concerned about the over-prescription of statins, which some say needlessly exposes people to side effects such as muscle pain and diabetes.

That view was backed by the authors of the new research.

Writing in the journal JAMA Internal Medicine, they said: ‘Our results do not provide support for a blanket principle that lower LDL- cholesterol is better for all patients in secondary prevention.’

The team found people who reduced their levels from a ‘high’ cholesterol level of more than 100 milligram per decilitre, to a ‘moderate’ level - between 70.1 and 100 mg/dL - were 13 per cent less likely to suffer heart attacks, angina, stroke or death.

But if they reduced their level from moderate to ‘low’ - below 70mg/dL and the ‘healthy’ target set by the NHS and European Cardiovascular Society - there was no reduction in major heart problems.

Rita Redberg of the University of California, who edits the JAMA Internal Medicine journal, wrote in a separate editorial: ‘The study adds important information to the ongoing discussion of the best statin strategy and LDL-cholesterol targets to improve outcomes with minimal harms.’

The research comes after a separate paper, published last week in the journal BMJ Open, suggested taking statins is a waste of time for anyone over the age of 60.

That paper, which involved academics and cardiologists from 17 countries, found no link between high LDL-cholesterol levels and heart deaths among over-60s.

The review, which combined 19 previous studies involving 68,000 people, even found hints that people with higher levels of LDL-cholesterol survived longer.

Statins have long been a source of controversy among doctors.

Many are uncomfortable with what they describe as the ‘over-medicalisation’ of the middle aged - doling out statin drugs to people ‘just in case’ they have heart problems in later life.

Dr Malcolm Kendrick, a GP from Cheshire, describes the ‘cholesterol hypothesis’ as ‘the greatest scam in the history of medicine’.

But others - notably leading members of the British Heart Foundation - view statins as invaluable.

Professor Peter Weissberg, medical director at the British Heart Foundation, said: ‘The findings in this paper question the notion that the lower the cholesterol levels achieved with statins the better it is for patients who have survived a heart attack.

‘However, it does not show that statins are ineffective.

‘There are a number of reasons why the conclusions from this research may be wrong and longer follow-up of the patients may provide a different result.

‘Patients who have had a heart attack should certainly continue to take their statin, since it will reduce their risk of suffering another heart attack.’

Dr Tim Chico, consultant cardiologist at the University of Sheffield, added: ‘We know already that statins definitely lower the risk of heart disease, and that the higher someone’s risk of heart problems the more cost-effective statins are.

‘I recommend patients keep an open mind when taking statins, but that they monitor for signs of side effects and that they openly discuss the reasons for being on them and the risks of side effects with their GP or cardiologist.’

Professor Colin Baigent of the University of Oxford, added: ‘In patients with heart disease it is clear from the evidence that pushing cholesterol as low as possible with statins saves lives.’

London cardiologist Dr Aseem Malhotra, who has long campaigned against the over-use of statins, said: ‘This very interesting study reveals that getting cholesterol as low as possible as low as possible from statins in people with established heart disease adds no extra benefit than a slight reduction.

‘This further substantiates that the modest benefits of statins are likely through anti-inflammatory mechanisms.

'The good news is that patients will get some benefit at a lower dose of the drug whilst simultaneously reducing the risk of side effects.'

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