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• White paper (9)
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• Statins (2)
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Letters to the Editor
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Statins
Produce the evidence for increased morbidity
From Ms M. Yassaie, MRPharmS
I disagree with what was said in John
Woodward’s letter (PJ, 17 February, p188). Does
Mr Woodward have the clinical evidence to prove that changing patients
from simvastatin to atorvastatin has increased the morbidity and mortality
of patients? Mr Woodward obviously does not know much about pharmaceutical
companies, otherwise he would have known that if there was even slight
evidence that a change in statin could harm a patient, the pharmaceutical
company, by now, would have made sure it would become front page news
in all the national newspapers. As a matter of fact, a recent study
published in International Journal of Clinical Practice (2007;61:2–3
and 15–23) finds switching from atorvastatin 10mg or 20mg to
simvastatin to have no significant detrimental impact on patient outcome.
Is Mr Woodward aware that few consultants in UK have the expertise to
evaluate papers on drugs critically and that most of their information
comes direct from pharmaceutical companies?
Finally, Mr Woodward has suggested that health professionals should make
the decision on the type of statin. May I remind Mr Woodward that these
decisions are made by highly educated and experienced health care professionals
like Brian Curwain (pharmacists are health professionals, are they not?)
who have the expertise of evaluating all the available data, free from
the influence of pharmaceutical companies.
Also, people like Dr Curwain have the responsibility of providing health
care for the whole of the population in their area, therefore they have
to make sure that the limited cash in the NHS is used thoughtfully. Drugs
used in the NHS have to be appropriate, effective and affordable otherwise
there would be no NHS left.
Mr Woodward should provide the evidence for his suggestion that any death
or ill health is due to change in statin. As health care professionals,
we should only give weight to evidence-based arguments.
Maha Yassaie
Chief Pharmacist
Berkshire West Primary Care Trust
Not so NICE guidance on the use of statins?
From Mr J. W. Clitherow, FRPharmS
The recent correspondence on statins in your issues of 3 and 10
February, and personal experience, make me wonder how many patients
really need to be taking them or are on an inappropriate dose regimen
because of the National Institute for Health and Clinical Excellence
guidelines.
Since first having had my cholesterol determined some five years ago
at the age of 70, my total cholesterol (TC) has varied between 6.1 and
7.1mmol/L with a high density lipoprotein cholesterol (HDLC) of 2.3mmol/L.
A routine blood check in September 2006 revealed no change from the TC
6.1 and HDLC 2.3 levels. An initial suggestion by a practice GP was to
try a “low dose” of simvastatin but the GP I actually saw
prescribed 40mg daily, which I queried, but he stated that the NICE “guideline” was
for a 40mg daily dose. After taking it for about a week, I developed
severe back, joint and muscle pains, which subsided about four days after
stopping the statin. Resumption resulted in a return of the pains, which
again subsided after cessation of the drug. I reported this to the GP
who then changed the statin to atorvastatin, again at a 40mg daily dose,
which, once again, I queried, only to be told that this was the “guideline” dose.
The pains returned, but worse, and after 18 days I stopped taking the
drug. A blood test two to three weeks later indicated a TC of 7.4 (rebound?)
and HDLC of 2.5 with a creatine kinase level of over 400U/L, indicating
muscle damage.
The pains are still there even after six weeks of cessation. Never having
had any cardiovascular problems and with a TC/HDLC ratio described elsewhere
as excellent were the reasons why I queried the prescribed dose. When
I queried the dose initially, I had the distinct impression that the “guidelines” were
being regarded as inviolable — perhaps a classic case of “one
size fits all”. Perhaps this was not the intention, but if so,
NICE should emphasise that the guidelines are just that and that GPs
should be able to use their professional judgement as to what dose to
prescribe or whether to prescribe any statins at all. Asking around it
seems that my experience is not an altogether unique one.
J. W. Clitherow
Sawbridgeworth, Hertfordshire
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