More older adults 'may benefit from taking statins,' study reports

Behind the Headlines

Tuesday August 1 2017

LDL cholesterol can cause narrowing and hardening of the arteries

Statins help reduce levels of LDL cholesterol

"Nearly all men over 60 and women over 75 eligible for statins, analysis suggests," The Guardian reports.

This is the finding of a study that aimed to see how many people in England would qualify for statin use if the 2014 NICE guidelines for statin therapy in adults were followed.

Statins are drugs designed to lower cholesterol, and in turn reduce the risk of a person developing a cardiovascular disease (CVD). The drugs are crucial for preventing another event occurring in people who already have CVD.

In 2014, the National Institute for Health and Care Excellence (NICE) produced guidelines that recommended that statins should also be prescribed for people with a 10% risk of developing CVD in the next 10 years.

The health watchdog selected a risk assessment tool called QRISK2 to estimate a person's risk of CVD based on a number of factors, such as body mass index (BMI), smoking history and whether family members had developed CVD.

This study cross-checked the NICE guidelines on statins with data from the 2011 Health Survey for England.

It found all men over 70 and all women aged 65-75 could potentially be offered statins based on the CVD risk associated with their age alone, regardless of how healthy they were.

Currently, around four million people are being treated with statins, so this would mean treating an extra seven million people.

It's not clear whether this would add to the NHS budget or actually save money in the long term by reducing the number of people who go on to develop CVD.

If you're concerned about your CVD risk, talk to your GP about the pros and cons of treatment.

Other ways to reduce your risk of CVD include stopping smoking, being more active, drinking less alcohol, eating more healthily, and achieving or maintaining a healthy weight.

Where did the story come from?

The study was carried out by an international team of researchers from the Harvard TH Chan School of Public Health in the US, and the University of New South Wales and the University of Melbourne in Australia.

The researchers were funded by the Swedish Society of Medicine and Gålöstiftelsen, and the HCF Research Foundation.

They also used data from the Health Survey for England, which was funded by the Department of Health and the Health and Social Care Information Centre.

The study was published in the peer-reviewed British Journal of General Practice.

Coverage of the study in the UK press was mixed.

Some papers accurately reported the results of the research, providing useful information from independent experts, who discussed how statins fitted into the bigger picture of preventing CVD.

Other outlets were less helpful, focusing more on other aspects of the debate on whether or not people should take statins.

The Times' headline "Give statins to almost all men over 60, GPs are told" is misleading as it implies that the study made definitive recommendations on public health policy, which it did not.

What kind of research was this?

The aim of this study was to see how many people in England would qualify for statin use if the 2014 NICE guidelines for statin therapy in adults were followed.

This cross-sectional study took a sample of people at a single point in time.

The researchers used data taken from the Health Survey for England (HSE), which is carried out every year to look at health and health-related behaviour in a sample of adults and children.

The information provided by that survey was used to calculate people's risk of CVD to see whether or not they would be eligible for statins.

The researchers then used their findings to estimate how many people in the whole English population might be offered the drugs.

What did the research involve?

The 2014 NICE guidelines say that people who don't have a history of CVD and who have a risk of 10% or more of having CVD in the next 10 years should be offered statins to reduce their risk.

A person's CVD risk is based on the results of a computer-based tool called QRISK2, which uses information about people's lifestyle and health to make predictions about their future health.

The researchers first looked at the QRISK2 tool to see how the results of the tool varied according to what information was provided about the various risk factors it looks at. They then explored how the tool classified people's risk using data from the HSE study.

The researchers took data from a single year of the HSE in 2011. The people from that year who were eligible for this study:

  • were aged between 30 and 84 years old
  • had provided a blood sample
  • had answered questions about lifetime history of CVD
  • didn't have data missing that would be needed for the QRISK2 tool

In total, 2,972 people were included in the study. The researchers calculated a QRISK2 result for each of the study participants.

They then compared the results with the general population to estimate how many people in the whole of England might be eligible for statins.

The analysis carried out was suitable for this type of study. But the decision to exclude people who had data missing on some risk factors could introduce bias in the results if these people were different from the people included in the study.

What were the basic results?

The researchers estimated that all men over the age of 70 and all women aged 65-75 could potentially be offered statins, as all people in those groups would have a QRISK2 score of 10% or more.

This result applied even if they were otherwise healthy. For people with other risk factors, the age at which they might be offered statins would be lower. 

If the NICE guidelines were completely implemented, 11.8 million adults aged 30-84 could be offered statins to reduce their risk of CVD.

How did the researchers interpret the results?

The authors noted that the QRISK2 tool puts a lot of emphasis on age, which means older adults are likely to have statins recommended to them by this tool even if they don't have many other risk factors for CVD.

They also discussed some of the pros and cons, both for individuals and for the health service, of more people being prescribed statins.

For example, they estimated that if the NICE guidelines were followed, 290,000 CVD events might be prevented.

But more resources would be needed in the health service to properly screen, treat and monitor the patients who were offered statins.

Of the 9.8 million people without previous CVD who would be eligible for statins, 6.3 million aren't currently taking them.

The researchers stated that statin therapy should only be started following discussion between the doctor and patient, particularly if the main or only risk factor a person has is their age.

Conclusion

The study was an interesting analysis of how many more people in England could be eligible to receive statins than those currently receiving them.

It didn't make any recommendations about acting on these findings. The study was also unable to follow people over time to see whether statins might have made a difference.

And the study did have some limitations:

  • Because it only looked at people at one point in time, we don't know whether the people who were considered at risk of CVD actually went on to develop it.
  • The researchers were only able to use one year of data from HSE, as this was the only year that had the information they needed about people's history of CVD.
  • Using more data may have detected trends, as CVD risk has changed in the population over time.
  • The study assumed that people in the HSE population were representative of the general English population when estimating how many adults could be offered statins. Although the HSE study is designed to try to be representative, there may be situations the survey population doesn't match the general population for a specific risk factor or condition.

It's best to talk to your GP if you think you'd benefit from taking statins or you're already taking them but have questions.

If you can't take statins or don't want to take them, other ways you can lower your cholesterol include stopping smoking, being more active, drinking less alcohol, eating more healthily, and achieving or maintaining a healthy weight.

Edited by NHS Choices

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