Statins of questionable value

Drugs designed to lower the levels of “bad cholesterol” in the blood could condemn middle-aged adults to a lifetime of popping pills of questionable value say a group of leading doctors and academics. Statins are prescribed to those diagnosed with cardiovascular disease (CVD), or whose personal and family medical history suggests they have a 20% change of developing CVD within the next decade. Draft guidance from the National Institute for Health and Clinical Excellence (NICE) published in February suggests lowering this to 10% to save more lives, meaning an additional five million people in England and Wales could be prescribed the drug. Professor Simon Capewell, from the University of Liverpool, said: "These recommendations are deeply worrying, effectively condemning all middle-aged adults to lifelong medications of questionable value." Many scientists believe that statins are overprescribed, and that their use has expanded into areas where they provide lesser benefit. Those taking the drugs are at risk of fatigue and psychiatric problems, while men may suffer erectile dysfunction, and women could become more susceptible to diabetes, say the group. “Research published last year showed that in day to day practice many (probably most) high risk patients are not getting statins and that many low risk patients are prescribed them. In fact patients at much lower risk than the levels being debated are often prescribed statins. In the real world the right patients miss out and the wrong patients are treated,” said Dr Tom Marshall, Reader of Primary Care at the University of Birmingham “My view is that we should concentrate efforts on targeting those at highest risk before we think about treating everyone else. It seems we are not targeting our efforts at the right patients and this should be our priority. Until we do this it does not really make much sense to think about treating medium or low risk patients.” More information Statins lower the level of low-density lipoprotein (LDL) cholesterol in the blood, by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of LDL in the liver, where around 70% of cholesterol in the body is produced. They mimic the natural substrate molecule, HMG-CoA, and compete for binding to HMG-CoA reductase, lowering the rate of mevalonate production, the next molecule in the serial steps to produce cholesterol. They were developed by Japanese scientist Akira Endo in the 1970s following a search for a cholesterol-lowering drug. His team identified mevastin (ML-236B), a HMG-CoA reductase inhibitor. Although never marketed because of its toxic effects in animals, it was considered the first statin.