Editorials

The use of statins: a case of misleading priorities?

Last month the NHS Executive distributed to health authorities and general practitioners a statement from the Standing Medical Advisory Committee on the use of lipid lowering drugs.¹ This argues for a strategy of treatment on the basis of underlying risk, but it adopts a level that is probably unachievable, fails to present the evidence, and ignores cost effectiveness. In so doing it jeopardises the objective of targeting high risk patients, but it also raises questions about the worth of guidance that does not link benefits and costs.

The statement recommends that, having considered other methods of reducing the risk of coronary heart disease, clinicians should give statins to the following three groups of patients. The first priority are patients who have had a myocardial infarction and have low density lipoprotein values of 3.2 mmol/l or more; second are those with angina or other clinically overt atherosclerotic disease with low density . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Economic benefit analysis of primary prevention with pravastatin

Paul Pharoah, Nick Freemantle, James Mason, and J Jaime Caro
BMJ 1998 316: 1241. [Extract] [Full Text] [PDF]

Patients offered treatment for CHD need full information to make decision

P McCormack, Marc Levine, and Robert E Rangno
BMJ 1998 316: 1021. [Extract] [Full Text]

Use of statins

Peter Enoch, R L Akehurst, Peter Sheridan, Peter Savege, Sue Silverman, Win Bennett, Wayne McNee, Scott Metcalfe, James M Wright, A S Wierzbicki, T M Reynolds, Alan Maryon Davis, D P Mikhailidis, A F Winder, J McMurray, A McGuire, M Raikou, C Morrison, Andrew P Wakeman, Robert H Leach, David Lewis, E J Wallis, L E Ramsay, W W Yeo, P R Jackson, M Pickin, I U Haq, John Betteridge, James Shepherd, Gilbert Thompson, John Kjekshus, and Terje R Pedersen
BMJ 1997 315: 1615. [Extract] [Full Text]

This article has been cited by other articles:

• Warburton, R. N (2003). What do we gain from the sixth coronary heart disease drug?. BMJ 327: 1237-1238 [Full text]  
• Reid, F D A, Cook, D G, Whincup, P H (2002). Use of statins in the secondary prevention of coronary heart disease: is treatment equitable?. Heart 88: 15-19 [Abstract] [Full text]  
• Freemantle, N., Hill, S. (2002). Medicalisation, limits to medicine, or never enough money to go around?. BMJ 324: 864-865 [Full text]  
• Toal, M., Walker, R. (2000). Angiotensin converting enzyme (ACE) inhibitors in the treatment of heart failure in general practice in north Cumbria. Eur J Heart Fail 2: 201-207 [Abstract] [Full text]  
• Swan, H. J. C. (2000). The Framingham offspring study: A commentary. J Am Coll Cardiol 35: 13B-17B  
• Haq, I.U., Ramsay, L.E., Jackson, P.R., Wallis, E.J. (1999). Prediction of coronary risk for primary prevention of coronary heart disease: a comparison of methods. QJM 92: 379-385 [Abstract] [Full text]  
• Freemantle, N., Mason, J. (1999). Not playing with a full DEC: why development and evaluation committee methods for appraising new drugs may be inadequate. BMJ 318: 1480-1482 [Full text]  
• Swan, H. J. C. (1999). The Framingham Offspring Study: a commentary. J Am Coll Cardiol 33: 1136-1140 [Full text]  
• Haycox, A., Bagust, A., Walley, T. (1999). Clinical guidelines---the hidden costs. BMJ 318: 391-393 [Full text]  
• Hingorani, A. D, Vallance, P. (1999). A simple computer program for guiding management of cardiovascular risk factors and prescribing. BMJ 318: 101-105 [Abstract] [Full text]  
• Unwin, N., Thomson, R., O'Byrne, A. M., Laker, M., Armstrong, H. (1998). Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors. BMJ 317: 1125-1130 [Abstract] [Full text]  
• Fairhurst, K., Huby, G. (1998). From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia. BMJ 317: 1130-1134 [Abstract] [Full text]  
• Pharoah, P., Freemantle, N., Mason, J., Caro, J J. (1998). Economic benefit analysis of primary prevention with pravastatin. BMJ 316: 1241-1241 [Full text]