NUIG study examines statin use in those without cardiovascular disease

NUI Galway
Image: NUIG

Questions the impact of clinical guideline changes as 61% of over 50’s in Ireland without cardiovascular disease are eligible for statins, rising from 8% in 1987

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26 April 2019 | 0

Changing recommendations of clinical guidelines for the prevention of cardiovascular disease has made a big impact on Irish statin use, according to Research from NUI Galway.

Published in the British Journal of General Practice, the study found that of those sampled in 1987, 8% of over 50’s without cardiovascular disease, were eligible for use of statins. In 2016, 61% were eligible. Also seeing a dramatic increase is the associated costs, moving from €14 million to €107 million.

The effectiveness of this major increase has also been called into question. To prevent one cardiovascular event in 1987, 40 people would need to be treated. To have that same impact in 2016, 400 people would need treatment.

Statins, cholesterol lowering drugs, are used both on those with established cardiovascular disease (secondary prevention) and those without prior cardiovascular disease (primary prevention).

A previous study from the same team found that nearly one-third of over 50’s in Ireland took statins. Of this group, nearly two-thirds took them as primary prevention.

As such, they are widely prescribed, making up a large portion of Irish drug expenditure. In 2016, they were the second most prescribed medicine on the medical card scheme.

The follow up study, published in BMJ, found statin use in those without cardiovascular disease to be of questionable benefit. Before being prescribed a statin, baseline cardiovascular risk is estimated using a GP’s risk calculators. If risk is thought to be higher than a certain threshold, statins may be recommended.

Yet, in most risk categories, there is uncertainty as to how statins benefit the patient. For low-risk patients, the benefit could be so minute that taking medication would not be justified.

Paula Byrne, SPHeRE scholar, J.E. Cairnes School of Business and Economics, NUI Galway, said: “Increased eligibility for statin therapy impacts large proportions of our population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of cost-effectiveness and acceptability to some low-risk patients.

“One would have to question whether some patients, who may achieve very small reductions in risk of cardiovascular disease by taking statins, would agree to take this medication were they fully informed. From a societal perspective, we need to ask whether or not statin use in such people represents value for money in the health sector.”

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