By Paddy Henry
Research conducted by NUI Galway has found that there are uncertainties around the benefits and risks of statin use.
Statins are among the most commonly used drugs in Ireland. They were originally intended for patients with a history of cardiovascular disease, but are now commonly used by people with no prior disease, to prevent cardiovascular disease in the future.
This ground–breaking discovery was the product of a five-year study on statin use, led by Dr Paula Byrne and Dr John Cullinan of the J.E. Cairnes School of Business & Economics at NUI Galway, along with Professor Susan M Smith from the Royal College of Surgeons Ireland. Their research has been published in the British Medical Journal.
To date, most studies have not differentiated between the impact of statins in those with and without cardiovascular disease, which makes it difficult for doctors to support patients when making decisions about taking statins. This new research explores the deficiencies in the available evidence. It shows that considerable uncertainty remains about the benefits of their use for primary prevention of cardiovascular disease and that the effects of statins in certain groups, such as women and the elderly, may differ from effects in middle aged men. In addition, the absolute benefits from statins for low-risk patients can be very small and patients may consider that they do not justify taking a daily medication for the risk of adverse effects.
Currently, almost two thirds of Irish adults over the age of 50 without a history of cardiovascular problems are able to access statins, despite questions marks surrounding the benefits of taking the cholesterol lowering medication.
The research shows that for lower risk categories, many people may need to be treated to prevent one serious cardiovascular event. The authors also highlight that much of the data on the side effects of statins remains unavailable for independent analysis and have called for better data on both the benefits and harms of statins, in particular for low-risk populations, in order to better facilitate shared decision making.
Lead author of the study, Dr Paula Byrne, called on the medical profession and society to change their attitude around statin use, arguing, “Some patients may achieve very small reductions in risk of cardiovascular disease by taking statins. As a result, the individual patient and their doctor need to consider if these reductions justify taking a medication daily and the risk of side effects. From a societal perspective, we need to ask whether or not statin use in such low-risk people represents value for money in the health sector”.
Co-author of the study, Dr John Cullinan, spoke of the problems that overuse of medicines, such as statins, cause at a budgetary level and called for a change at policymaking level, stating, “In the context of overstretched healthcare budgets, the concept of overuse of medicines and low-value care should become integral to policymaking and reimbursement. We have highlighted one area of drug spending that warrants more careful consideration and would urge those responsible for the implementation of health policy and Sláintecare to seriously consider and deal with areas of potentially wasteful spending”.
Susan Smith from the Royal College of Surgeons in Ireland, and co–author in the study, also called on the medical profession to employ more evidence–based thinking and provide clarity to patients when it comes to statin use. “Given the on-going debate on the appropriateness of statin use in primary prevention, it is significant that the evidence to support this use is so limited, particularly for women. Doctors need more evidence on the benefits and harms of statins in low-risk individuals to support shared decision making with patients”.