NICE to review its guidelines on statins

Should everybody take statins? There has been much media coverage of a new study which seems to suggest this.

Statins are used to lower cholesterol levels in those with a moderate to high risk of a heart risk but the new study of 17,800 men and women found that those with normal cholesterol were less likely to have a heart attack too if they took statins.

Overall, 20mg a day of rosuvastatin reduced the chance of a heart attack, stroke, hospital admission for chest pain or death from cardiovascular disease by 44%, researchers said. After an average follow-up of two years, the drug was also found to have cut cholesterol by 50% and C-reactive protein by 37%. (C-reactive protein is a guide to inflammation in the body and, therefore, to possible future heart problems.)

The study, which was published in the New England Journal of Medicine, was funded by drug company AstraZeneca's whose statin product Crestor was used in the research.

There has been understandable excitement about these findings with one GP quoted by the BBC calling them 'astonishing'.

Side-effects

NICE, the independent body providing national treatment guidance to the NHS, is to review its guidelines on statins shortly. Currently, it recommends statins for patients calculated as having a 20% risk of a heart attack or stroke in the next 10 years. When reviewing their guidance they'll be looking at the side-effects as well as the benefits.

The main side-effect seen in this study was a slight increase the numbers of people with diabetes in the group taking statins. The manufacturers also admit the drugs can cause severe muscle problems. Moreover, some patients have complained of confusion and mental problems while a comprehensive review of previous statin studies showed an increased risk of cancer.

Research in the Journal of the American College of Cardiology reviewed the results of 13 trials involving more than 41,000 patients and detected higher rates of cancer among the patients whose use of statins achieved the lowest levels of LDL (bad) cholesterol. Again the cancer risk was relatively small - one extra case of cancer for every 1,000 patients.

Is it worth it?

These risks may be worth running by people with a high risk of a heart attack but whether they're worth running by large numbers of otherwise healthy people is less clear. If vast swathes of the adult population are taking statins, even very small percentages will translate into large numbers of real people with real side-effects.