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Letters to the Editor
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Statins
Pharmacists should be aware of the benefits
From Professor J. Smith, FRPharmS
Cardiovascular disease (CVD) is the leading cause of death in England,
with 238,000 deaths in 2002. It accounts for about a third of all premature
deaths. Non-fatal CVD can seriously impair quality of life and is estimated
to be the leading cause of disability in Europe. Mortality rates are declining,
thanks to a combination of lifestyle changes, improved diagnosis, improved
treatment and better primary and secondary prevention. We are on course
to achieve the national service framework target of a 40 per cent reduction
in mortality over 10 years. Effective use of statins is central to this
strategy. It is therefore unfortunate to see the recent National Institute
for Health and Clinical Excellence guidance on statins, for the prevention
of cardiovascular events, dismissed in your columns as “no
more than a gamble” (Broad spectrum, 11 March, p290).
The meta-analysis of primary prevention trials commissioned by NICE showed
that in people without CVD, taking a statin reduced the risk of fatal myocardial
infarction (MI) by 59 per cent and of non-fatal MI by 40 per cent. To someone
at or above the new NICE threshold for treatment (a 20 per cent risk of
developing CVD over 10 years), this means statins offer a substantial degree
of protection against premature death or disability. If anything, the NICE
guidance is conservative. New Zealand national guidelines recommend statins
at, or above, a 15 per cent 10-year CVD risk. And, a Canadian analysis
published last week showed that treating at the 15 per cent risk level
would save 35,800 lives over 10 years — nearly 0.3 per cent of the
entire population.
The real gamble would be for people at risk — and their professional
advisers — to reject the benefits that statins offer. A Market and
Opinion Research International poll in 2003 showed that people use pharmacists
as a health resource, second only to GPs. In “Choosing health through
pharmacy”, ministers powerfully supported our expanding role as advocates
for health. Pharmacists would be in default of that role were they to fail
to advise people, in the light of their own particular circumstances and
wishes, that statins can significantly protect their health.
Jim Smith
Professor of Pharmacy Practice and Policy
University of Sunderland
References
1. Department of Health. The coronary heart disease national framework:
progress report 2005. London: Department of Health; 2005.
2. New Zealand Guidelines Group. Assessment and management of cardiovascular
risk. Wellington: New Zealand Guidelines Group; 2003.
3. Manuel DG, Lim J, Tanuseputro P. Revisiting rose: strategies for reducing
coronary heart disease. BMJ 2006;332:659–62.
4. Worcester RM. Patient choice. London: Market and Opinion Research International;
2003.
5. Department of Health. Choosing health through pharmacy: a programme
for pharmaceutical public health. London: Department of Health; 2005. |
The
Pharmaceutical Journal