Statins – £450 million a year set to increase

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  • Statins – £450 million a year set to increase
  • Statins to be prescribed to more people

    We already spend £450 mill a year on them and it appears that is going to increase.

    I thought the science behind them was very debatable and they cuased a lot of side effects?

    Somebody is getting very rich from this.

    Premier Icon kimbers
    Subscriber

    how dare the NHS spend money on making sick people better!!

    making sick people better!!

    Do statins do that? Serious question.

    Premier Icon kimbers
    Subscriber

    yes millions every day (also protective against some forms of cancer)

    NICE have done this because the cost of treating people after heart attacks is greater than the cost of the drugs themselves (and the small% of side efefcts)

    Premier Icon tomhoward
    Subscriber

    They made me better. (reduced cholesterol from 7.odd to 4.8) I’m off them now.

    Changing to a job that wasn’t next to a chippy *may* also have assisted this reduction.

    They do seem to have a bad rep, I know my mother was petrified I’d have bad side effects (I didn’t have any) and alot of people (women, mainly) at work recoiled in horror at the mention of them. Why so bad?

    Premier Icon chakaping
    Subscriber

    Interesting to see how this will pan out when I go back to the GP next year for my two-year catch up.

    I’m just below the borderline and one GP was quite keen to get me on the pills, while another was on the fence and a third said he didn’t think it was necessary (I’ve been moving around, not seeking three opinions).

    I would prefer to stick with the lifestyle-based approach and special margarine myself but if people won’t change their lifestyle then I can see the logic.

    MrsSponge works in a pharmacy and is amazed at how many people are on statins. Not nice things to be on and far from ideal. Lots of people (including some GP’s) see them as a way to allow people to continue their unhealthy lifestyle rather than make changes to benefit them. If you can, change your diet/lifestyle.

    Its also amazing how much of a lottery the NHS is, one patient has moved from Wales and can no longer get the HIV medicine he has been taking for the past 10 years as the local NHS ‘trust’ deem it too expensive so now he has to find another one that he wont suffer bad side effects from. Disgusting when you consider some of the things that they will do. Although the wastefulness of patients is astronomical too.

    Premier Icon alibongo001
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    Its worth looking up some of the studies if you doubt the effect of statins on populations. A significant number of people are around today because statins prevented an event (or more) that would have seen them die.

    I guess there is some comfort in the fact that governments / health systems around the world must be convinced of their value to spend so much money on them – and these are the people who are trained to be able to decide if it is worth it.

    Lipitor is the biggest value drug ever in the history of man from a £ perspective.

    They are mostly generic now which means that they costs a fraction (20%) of what they used to and are really good value for money interventions.

    Of course the Daily mail will have you believe that the side effects are terrible for everybody and they should be withdrawn. (In reality the side effects can be terrible but only a few will have them to the level that it requires withdrawal)

    One of the issues of this type of drug is that they don’t appear to do anything for the user, sure a number goes down when they visit the GP but there when they stop an event happening there is no fanfare – patient and doctor never know that an event should have happened!

    Premier Icon stever
    Subscriber

    If only the ‘going for a walk and eat some salad occasionally’ industry had as much political influence as Big Pharma.

    Its worth looking up some of the studies if you doubt the effect of statins on populations. A significant number of people are around today because statins prevented an event (or more) that would have seen them die.

    There seems to be a lot of “bad science” behind the whole “cholesterol is bad for you” debate.

    The doctor who does my work medical says it’s a load of bollocx and isn’t a major factor and also statins are really bad for you but my GP wanted to put me on statins when my cholesterol was at the high end of normal.

    Makes you think.

    Premier Icon kimbers
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    stever – Member
    If only the ‘going for a walk and eat some salad occasionally’ industry had as much political influence as Big Pharma.

    dont know much about Familial hypercholesterolemia, do you?

    edit: and nor does winston’s work doctor

    I was on statins for a while when I first started suffering from Angina.
    They helped get my cholesterol level down from 9.6 to a steady 4 ish, but also gave me intense joint pain to an extent that I walked like Oddbod from Carry on screaming. I tried them all but the only solution was to come off them.
    Healthy eating and exercise has maintained my level at 4 ish ever since.
    My 88 year old father is on Simvastatin. He suffers pains in his ankles and knees. His GP refuses to believe there may be a connection. Unfortunately my father is of a generation who trust doctors implicitly and he refuses to stop taking the statins even for a month or so to see if the pains diminish…

    Was only in the press last week about the potential side effects causing kidney damage not to mention the side effects when its taken with amlopdine ( to treat high BP ) coz it can lead to muscle mythopy .

    Premier Icon kimbers
    Subscriber

    but if the side effect of not taking them is a heart attack?

    x3 bypass surgery costs the NHS £10000 a pop, statins as little as £50 a year pp

    Premier Icon alibongo001
    Subscriber

    One of the things is that policy is written for populations

    Experience is down to individual people.

    Statins do individuals harm (side effects) but populations good (reduced events and other pleiotropic effects)

    ninfan
    Member

    bypass surgery costs the NHS £10000 a pop, statins as little as £50 a year pp

    Yes, but if that means dosing 140 people unnecessarily to prevent one heart bypass, and at the same time had to treat several of them for cataracts, erectile disfunction, diabetes etc – then the saving is much more marginal.

    Premier Icon kimbers
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    NICE is ruthless with cost efficiency, remember the fuss over herceptin?

    if it saves money (and lives) then its worth it especially if the worst case scenario is that 80% have no side effects

    Premier Icon sam_underhill
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    They helped get my cholesterol level down from 9.6 to a steady 4 ish

    They made me better. (reduced cholesterol from 7.odd to 4.8)

    Massive assumption that 9.6 & 7 values are bad for you. The accepted norm of a cholesterol value of 5 is based on what exactly?

    Premier Icon bails
    Subscriber

    I’ve got a friend who’s been on statins since he was about 20. There’s a genetic disposition in his family to massively high cholesterol levels that can’t be controlled by diet/lifestyle alone.

    I think it was a case of take the statins or suffer a huge heart attack before you get to 30.

    Premier Icon kimbers
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    sam_underhill – Member
    The accepted norm of a cholesterol value of 5 is based on what exactly

    siighhhhhh

    Premier Icon tomhoward
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    Massive assumption that 9.6 & 7 values are bad for you. The accepted norm of a cholesterol value of 5 is based on what exactly?

    What people who are much better experienced and knowledgable in the field have told me.

    Do you research every single standard/accepted norm that affects your life?

    Premier Icon sam_underhill
    Subscriber

    Do you research every single standard/accepted norm that affects your life?

    No. But I’m not so blinkered, that I believe it without the possibility that it could be wrong. Do you really accept that all the stats coming out of big pharma companies are true?

    Premier Icon tomhoward
    Subscriber

    Do you really accept that all the stats coming out of big pharma companies are true?

    No, but I do think that doctors are infinitely more cabable than I at interpreting those stats when it comes to prescribing something. Also for them (and the research around the subject) to know when a level is too high/what is acceptable. Actually sod it, I’m going to let my cholesterol run to 300 as I think that is right for me.

    Premier Icon kimbers
    Subscriber

    sam_underhill do you really think that ‘big pharma’ supply these stats to the NHS?

    the figures in this case are dependent on the last 40+ years of medical research, the majority of which is funded by government/ charities and carried out by doctors, clinicians, scientists, statisticians and medical staff who very much care about the health of their patients
    of course there is a danger that commercial interests can influence public health decisions, fortunately the data isnt provided by some Mr Burns type guy that runs Pfizer

    Premier Icon sam_underhill
    Subscriber

    but I do think that doctors are infinitely more cabable than I at interpreting manipulating those stats

    FTFY

    Premier Icon kimbers
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    so youre saying doctors actually just want to kill all their patients?

    id say keep taking the tablets but Im guessing that youve come off them because the voices told you they were making you crazy.

    Premier Icon tomhoward
    Subscriber

    Kimbers, you appear not to understand. They are out to kill us.

    Out of interest Sam, from your apparent lofty position as The Knowledge on the subject, what is the ideal level, and which statin is best?

    Premier Icon sam_underhill
    Subscriber

    kimbers – I don’t assume that the pharma companies are automatically bad. I’m just open minded that not all the research is always correct. In this particular case, assuming that statins are universally a good thing is probably a mistake, and in particular with reference to Cholesterol.
    I’m not saying don’t take statins, just don’t take them without consideration of the side effects and, as there are questions over the use and benefits of them, wouldn’t you do some research as to whether they are right for you?

    Premier Icon kimbers
    Subscriber

    well as Im currently working as a research scientists at the UCL Institute for Cardiovascular Genetics, looking at developing treatments for people with mutations in their LDL receptors id like to think I have access to enough information to make an informed decision.
    Im also quite happy to accept the assosciation between cholesterol levels and CHD and the benefits offered by Statins in lowering cholesterol has in preventing strokes, heart attacks and generally making you live longer. Id happily reccommend them to my friends and family.

    and for reference
    Im funded (poorly!) by the British Heart Foundation and not [scary voice] ‘big phaaaaarmaaaaa’ [/scary voice]

    Premier Icon tomhoward
    Subscriber

    kimbers steps up to the plate and….

    Unless, he’s one of them.

    Premier Icon stever
    Subscriber

    dont know much about Familial hypercholesterolemia, do you?
    On the contrary (thanks mum!). But it’s a simple solution to a complex problem.

    They helped get my cholesterol level down from 9.6 to a steady 4 ish

    They made me better. (reduced cholesterol from 7.odd to 4.8)
    Massive assumption that 9.6 & 7 values are bad for you. The accepted norm of a cholesterol value of 5 is based on what exactly?
    Given that I was suffering from Angina at the time and subsequently had 5 stents and a double bypass to fix clogged up plumbing I think we can assume I wasn’t the healthiest,despite being 185cm and only 75kg…

    mogrim
    Member

    kimbers – Member
    well as Im currently working as a research scientists at the UCL Institute for Cardiovascular Genetics…

    lol, pwned 🙂

    Premier Icon sam_underhill
    Subscriber

    Im also quite happy to accept the assosciation between cholesterol levels and CHD

    I think is the main thing here. Statins almost unanimously lower cholestorol, but is there actually a proven link between high cholesterol and CHD? Also, what constitutes “high”? I’m not looking for an answer from the forum, just pointing out that there may not be a single answer for everyone, and blindly taking a drug with known side effects may not be a simple decision.

    Sounds like looking at the evidence available, kimbers is happy to recommend statins.
    I, on the other hand, am open to the suggestion that some of the information may be misinterpreted / misunderstood. That’s all I was trying to point out.

    lol, pwned

    Hmm, not necessarily.

    As I (a layman) understand it the BHF is still advocating that we eat truckloads of “heart healthy wholegrains” and is selling its Red Tick to the highest bidders.

    (As a well read layman) I also understand that there is an almost overwhelming amount of evidence against eating wholegrains because, well, they are not heart healthy in anyway shape or form.

    Now, I’m not one for conspiracy theories as they are patent nonsense in the overwhelming majority of cases. But if you look at the money trail then there might be a case to be made that the BHF has a vested interest in protecting the current status quo and ensuring that the mainstream advice of eat a high carb, low fat diet to be healthy is not corrupted by edgier science.

    legolam
    Member

    Can’t believe I’m going to get sucked into this, but here goes.

    The evidence for statins in preventing both death after a heart attack (secondary prevention) and death in those without known cardiovascular disease (primary prevention) is overwhelming. Their mode of action isn’t fully known, but we know that it’s not all about absolute reduction in cholesterol levels (because non-statin drugs like ezetimibe reduce cholesterol but don’t save lives).

    However, we’ve known that there is a link between high cholesterol and cardiovascular disease since the Framingham Heart Study in the 1940s. This was the first study to observe the link between smoking, high blood pressure, lack of exercise, obesity and high cholesterol with cardiovascular disease.

    We’ve known that statins work since the mid-1990s with some very big trials eg:
    1) 4S study – a Scandinavian study of >4000 people WITH cardiovascular disease showed that treatment of 100 patients for six years would prevent four deaths of the disease and seven non-fatal myocardial infarcts (Wiki link)
    2) WOSCOPS – a study from Glasgow that looked at >6500 patients WITHOUT cardiovascular disease and showed that statins prevented death from cardiac causes (compelling evidence here)

    From a personal, anecdotal, point of view, it’s a well held belief amongst my cardiology colleagues that statins have contributed significantly to the decline in major heart attacks that we’ve seen over the last 20 years. And that can only be a good thing (unless you’re training to be a cardiologist and you’re worried that statins might put you out of a job…)

    legolam
    Member

    Somebody is getting very rich from this.

    The patent for simvastatin ran out in the UK in 2004.

    A month’s prescription for simvastatin 40mg costs £1.16.

    A month’s prescription for simvastatin 40mg costs £1.16.

    So?

    Doesn’t stop it from being profitable if you sell them by the million.

    Premier Icon kimbers
    Subscriber

    legolam, you cant win, just walk away 😉

    Grandad dead at 64 from a heart attack. Uncle dead at 68 from heart disease. Mother disabled at 70 with vascular dementia.

    Despite a healthy, active lifestyle, there’s a good chance I’ll be dead or doolally before I reach retirement age.

    There is a chance that Statins may reduce this risk. I haven’t noticed any side effects and they are a lot cheaper than those alternative remedies that consist of only water.

    And thanks to Kimbers and his colleagues for actually doing the research

    Premier Icon footflaps
    Subscriber

    Doesn’t stop it from being profitable if you sell them by the million.

    Once a drug is out of patent anyone can make it, so the profit margin is tiny (a few %).

    Premier Icon stever
    Subscriber

    From that BBC link at the top: “Currently, doctors are meant to offer statin tablets to the estimated seven million people who have a 20% chance of developing cardiovascular disease over 10 years, based on risk factors such as their age, sex, whether they smoke and what they weigh.”

    You can’t do too much about your age and sex, but the other two are highly influencable. (I thought we were having a chat by the way, not trying to win.)

    Kimbers and Legolam make valid points and are probably massively frustrated by the great unwashed giving them a hard time. But from the point of an individual, being told that studies and stats hold the answer is equally frustrating – I am not a number.

    Stats and studies can be used to prove any point of view – for example, the fact that saturated fat causes heart disease was the personal belief of one Ancell Keys. A study that he ran to prove this point of view failed to show a correlation between fat and heart disease (this was pre trans fat days), so he tidied up the data to make it fit with his personal point of view. Keys work has now been utterly discredited. But his work was scientific and peer reviewed and published in respectable journals, so why should we believe anything from supposedly credible journals?

    Equally, the link between cholesterol and heart disease is being questioned – that’s not to say that there isn’t a link, just that a more nuanced understanding is emerging. For example, not all LDL is created equal and there are vLDL particles that do the damage. Yet, just because you have a high LDL count it does not necessarily follow that you high vLDL. See, it’s nuance.

    When you see a GP or cardiologist in the UK they don’t want to talk about vLDL because it challenges the accepted orthodoxy that they have loads of studies to support. Those studies are valid, but they don’t tell the whole story and shouldn’t be relied upon blindly. Remember Ancell Keys?

    And if you were to ask a GP or cardiologist about inflammation markers, then watch the colour drain from their faces. Inflammation, not cholesterol (although it clearly plays a role), is likely to emerge from the beloved literature as the biggest cause of heart disease. So, cholesterol is likely a symptom, not a cause.

    What causes inflammation? An increasing number of studies – for what they are worth – are finding a direct link to low fat diets and grains. And what does the medical establishment want you to eat? A low fat diet with lots of grains…

    Premier Icon cinnamon_girl
    Subscriber

    The NHS doesn’t like informed patients. 😐

    DrP
    Member

    Also, what constitutes “high”? I’m not looking for an answer from the forum, just pointing out that there may not be a single answer for everyone, and blindly taking a drug with known side effects may not be a simple decision.

    The real answer is..there is no answer…!

    In primary prevention (i.e. hoping to prevent heart attacks), we (GPs) review all teh factors you think that we don’t (age, sex, lifestyle, other health issues, BP etc etc etc) and then come up witha ‘risk figure’.
    I.e healthy ol’ me may have a cholesterol of 5.6 but have low risk. Overweight, diabetic Bob may have a cholesterol of 5.2, and benefit from statins.

    Google q-risk..

    We don’t just sit here mindlessly doing what ‘big pharma’ tell us to do… On wednesday mornings and Friday lunchtime, we do actually sometimes think for ourselves and involve patients in the discussion too…

    DrP

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