Intended for healthcare professionals

Rapid response to:

Analysis

Should people at low risk of cardiovascular disease take a statin?

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6123 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6123

Rapid Response:

Re: Should people at low risk of cardiovascular disease take a statin?

Although statins are effective in reducing cardiovascular events even in people at low risk,[1] population benefits from more widespread use of statins will only occur if a sufficiently high proportion of people at lower cardiovascular risk (whether based on a formal risk assessment or on age alone) are prescribed statins. Early evidence from the NHS Health Check Programme suggests that achieving high statin uptake in people at low cardiovascular risk will be difficult to achieve. NHS Health Check is a population-wide primary prevention programme that was established in England by the Department of Health in 2009.[2] The programme represents a major investment in the prevention and early detection of cardiovascular disease.

In early results from the programme, prescription of statins in people identified to be at high cardiovascular risk (=> 20%) increased from around 25% to only 45%.[3] Prescribing of statins is likely to be substantially lower than 45% in people at lower (10-20%) cardiovascular risk. The relative contributions of physician and patient factors in the low uptake of statins in people assessed by the NHS Health Check Programme remain to be definitively elucidated. Preliminary findings from evaluations of the programme suggest that many people are reluctant to be prescribed long-term statins and thereby put themselves at risk of experiencing side-effects; and to undergo the regular monitoring required for people on statin therapy.[4] Statins may be both clinically effective and cost-effective but increasing their use in people at low cardiovascular risk will be difficult to achieve in clinical practice.

References
1. Cholesterol Treatment Trialists' (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 201210.1016/S0140-6736(12)60367-5.
2. Dalton AR, Soljak M. The Nationwide systematic prevention of cardiovascular disease: the UK's health check programme. J Ambul Care Manage. 2012 Jul-Sep;35(3):206-15.
3. Dalton A. R., Bottle A., Okoro C., Majeed A., Millett C. Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: Cross-sectional study. Journal of Public Health 2011;33:422–429.
4. Majeed A. Population-based risk Reduction for Cardiovascular Disease, Diabetes, and Kidney Disease in England. SGIM Forum 2011;34:9-13. https://skydrive.live.com/redir?resid=BFCC2CE4F2157051!281&authkey=!AGHt...

Competing interests: No competing interests

10 November 2013
Azeem Majeed
Professor of Primary Care
Imperial College London
Department of Primary Care & Public Health