Statins 'don't work well for one in two people'
Cholesterol-lowering "statin" drugs taken by millions
of Britons may not work well enough in about half of those prescribed them,
research suggests.
UK
investigators looked at 165,000 patients on statins and found that for one in
two, the drugs had too little effect on bad cholesterol - one of the big risk
factors for heart disease.
They
are not sure why statins appear to help some more than others.
Patients
should not stop taking the drugs without seeing their doctor.
One
possible explanation is patients not taking their prescribed drugs or doctors
giving them at too low doses, experts suggest.
Cardiovascular
disease kills about 150,000 people in the UK each year.
"Bad" low-density lipoprotein (LDL) cholesterol is a
major contributor - it can lead to furring and blockage of blood vessels.
Smoking
and obesity
Cutting
down on saturated fat can help lower bad cholesterol, but some people will also
need medication. Millions of people in the UK are given statins for this
reason.
But
statins can cause side effects and there is a debate about how many patients
should be prescribed them.
The
study, published in the journal heart, included 165,411 patients who
had been put on statins to cut their risk of developing heart disease by
lowering their cholesterol to a healthy level.
Half
of the patients - 84,609 in total - did not see their cholesterol go down by
enough - the required 40% or more reduction specified by guidelines - even
after being on the daily treatment for two years.
Experts say the
study findings are somewhat limited because they cannot prove that patients who
do not respond well to statins will necessarily fare worse as a consequence.
Other factors - like smoking and obesity - also raise cardiovascular risk.
But the work does
provide "real life" data and experience to draw on.
Researcher
Dr Stephen Weng, from Nottingham University, said: "Our research has
shown that in almost half of patients prescribed statins, they are very
effective and offer significant protection against cardiovascular disease.
"However,
for the other half - whether it's due to your genetic make-up, having side
effects, sticking to the treatment or other medications - we don't see that
intended benefit."
'Mixed
messaging'
In
the study, a higher proportion of patients with a sub-optimal response to
statins were prescribed lower potency doses, compared with those with an
optimal response.
He
said: "We have to develop better ways to understand differences between
patients and how we can tailor more effective treatment for those millions of
patients who are simply blanket-prescribed statins."
Prof
Metin Avkiran, associate medical director at the British Heart Foundation,
advised: "Statins are an important and proven treatment for lowering
cholesterol and reducing the risk of a potentially fatal heart attack or
stroke.
"If
you have been prescribed statins, you should continue to take them regularly,
as prescribed. If you have any concerns you should discuss your medication with
your GP. There are now other drugs available to help lower cholesterol levels,
and it may be that another type of medication will be an effective addition or
alternative for you."
Prof
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: "When
we prescribe medication, we have to rely on patients to make sure that they
take it, both at the recommended dose and for the duration of time that we
think will benefit them most.
"There
is a substantial body of research showing that statins are safe and effective
drugs for most people, and can reduce the risk of heart attacks and stroke,
when prescribed appropriately - but controversy remains around their widespread
use and their potential side-effects.
"There
are complex reasons why patients choose not to take their prescribed
medication, and mixed messaging around statins could be one of these."
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