papers p 983

The United States Food and Drug Administration has recently rejected proposals by the manufacturers of lovastatin and pravastatin to make these drugs available over the counter. Advisers to the Food and Drug Administration decided that physicians should probably determine who should get the drugs as well as monitoring them for side effects. The main arguments for allowing over the counter sales were summarised in a recent conference sponsored by the industry: statins are effective, easy to take, and relatively safe, and many people who should be taking these drugs are not doing so.1

The underuse of statins is most apparent in the secondary prevention of heart disease in patients with known atherosclerotic disease, for whom there is overwhelming evidence that statins are highly beneficial. 2 3 In one recent survey, for example, only 37% of patients with recent myocardial infarction and blood cholesterol concentrations above 2 g/l had been given drugs to lower their lipid concentrations and few had reached their target cholesterol concentrations.4 Most patients with heart disease have concentrations of low density lipoprotein cholesterol that warrant treatment, and making statins available over the counter might increase their use (as has occurred with aspirin).5

Undertreatment is also a problem for the much larger population …