British Medical Article details some major barriers to the planned widening of statin prescribing

Earlier this year, the National Institute for Health and Care Excellence (NICE) suggested a reduction in the threshold beyond which statin therapy should be considered (from a 10-year risk of cardiovascular disease of 20 per cent to 10 per cent). Some people believe this can only be a good thing. I believe that these people generally haven’t embraced the evidence in the area and/or hopelessly biased.

The fact is hardly anyone at low risk if cardiovascular disease will benefit from taking statins. And of course they’re not without risk. But we don’t really know what the risks are because, as I’ve pointed out before, the research is conceived, designed, conducted and reported in ways which mean adverse effects will simply not be logged or ‘go missing’.

Last week, the British Medical Journal carried an interesting opinion piece from Professor Azeem Majeed – a general practitioner and professor of primary care based in London, UK [1]. In his piece, Professor Majeed details three major objections to the widening of statin prescription to people at lower risk.

He first points to the fact that the proportion of health budget spent on primary care (general practice) has fallen. Also, it is well known that primary care doctors and services are placed under increasing demand. I can’t remember meeting a GP (family physician) in recent times who has not confessed to finding their workload and government-imposed requirements as very onerous. Professor Majeed writes:

…despite already being overstretched and underfunded, general practices will have other major new areas of work to take on, such as hospital admission avoidance schemes, improved care for older patients, longer opening hours, and more rapid access for people with acute medical problems. General practices may not be able to cope with all these additional areas of work and at the same time further expand access to statins unless the government were to increase the funding that general practices receive.

The second point Professor Majeed makes is that essentially healthy people may need to be ‘persuaded’ to take statins. My my experience tells me that most healthy individuals who take statins do so because they are scared not to. Usually, their doctor has given them a thoroughly jaundiced view of the value of the statins and the likely benefits. My experience is that when individuals are given the facts based on research (not rhetoric), they almost universally choose to give statins a miss. One could argue that if statins really were as effective as some doctors and researchers like to claim, then little persuasion would be necessary.

The final point Professor Majeed makes concerns the thorny subject of side-effects. In essence, he asks if we really know what the risks of taking statins are. He draws our attention to the fact that there appears to be a higher incidence of side effects in real world settings compared to that yielded by clinical trials. But, as we know, there are many reasons why this may be so (as I alluded to in the second paragraph). Professor Majeed comments that:

The discordance between the evidence from clinical trials and from clinical practice needs to be investigated so that doctors and patients are given accurate information about the risks and benefits of long term statin treatment.

To my mind, Professor Majeed’s is a thoughtful piece about why some have major reservations about the planned expansion of statin prescribing. It comes from someone who works on the front line, and perhaps knows the futility of trying to ‘sell’ patients a treatment which is quite ineffective and the safety of which is in doubt.


1. Majeed A. Statins for primary prevention of cardiovascular disease. BMJ 2014;348:g3491

9 Responses to British Medical Article details some major barriers to the planned widening of statin prescribing

  1. Lynn van Dyke 6 June 2014 at 3:09 pm #

    I took Simvastatin. I had aches and pains but thought it was age related. Then I took Omeprazole for reflux. I started with diarrhoea so stopped them. Then for about 5 days I had unbelievable pain like my hands and feet had been smashed with a mallet. I was awake all night with it as I felt I had to pace up and down, it was the only relief I could get for some reason. A and E the next morning…they didn’t know what it was and gave me pain killers. It was never documented as a side effect. I read on a paper someone had written that those two drugs shouldn’t be prescribed together…but as I say, it wasn’t written down anywhere!

  2. Vanessa 6 June 2014 at 9:05 pm #

    Lynn, there is a useful drug interaction link on where you can check combinations of drugs. You can add several drugs to check (may have to find the American alternative name) but it only checks interactions between 2 at a time as the data for multiple cocktails doesn’t exist…..still, better than nothing I suppose?

    I looked up Simvastatin and Omeprazole – here’s the link, although I don’t know if it’ll work as they probably put cookies on my pc to retrieve it. If so, please accept my apologies but you can check yourself on the site:,2067-0

  3. Jennifer 7 June 2014 at 12:39 am #

    My GP would not agree to me stopping Simvastatin 40mg. I had many of the disabling side effects that are currently attributed to statin ingestion, but the GP refused to acknowledge that statins could possibly be the cause of my deteriorating health.
    So, having independently removed statins from my life, and susequently re-gained my health, I wonder where I belong in the current debate regarding referral, or in my case, non-referral of side effects?
    I cannot possibly be included in data showing those presenting with side effects, let alone data counting those who have actually stopped taking the drugs. My GP was/is in denial, and has not seen or heard from me in 16 months. ( maybe I am dead, as was suggested might happen). I wonder how many other refusaniks are unaccounted for?
    Faulty data collection at the sharp end of any problem must inevitably lead to meaningless gibberish at the other end.. How does it go? Garbage in— garbage out. Sounds about right to me.

  4. Marie 7 June 2014 at 7:29 am #

    Woman – simvastatin
    “cotton” in her head

    I live in Sweden.

    I have never taken statins nor would I.
    It doesn´t matter what circumstances.
    Several people close to me did and that made me look for information in many different places. This started in 2004.

    Since then I have read many books, most of them from USA, Canada and England.

    I have also heard one patient story after the other although I have nothing to do with health care. I am interested and want to learn more.

    A few days ago, I spent some time together with a woman (around 65-70). We were waiting for the bus. She told me that she had pains in her back, and after some explaining, I asked her if she was on simvastatin for instance
    She said – not at the moment – but I took it for five years but stopped.
    I wondered why – she answered – I had cotton in my head,

    She had suspected the medication and stopped – and the problem disappeared.
    Then, she had restarted and the “cotton” came back.

    She had heard (I suppose from her doctor) that there was another statin that was not supposed to give this problem, but so far she had not taken it. It was atorvastatin (=Lipitor).

    I told her that all statins have similar side effects and they will appear – sooner or later.
    When that happens, some people are told that it`s just “old age”, others will get different diagnosis (=more medications).

    She had told her doctor but was not certain that her suspected side effect had been recorded.

    I ended the conversation because her bus came.
    Otherwise, I would have told her about Duane Graveline´s first book, Lipitor – thief of memory which was released years ago. Evidently her doctor had not ready it.

    There are lots of stories at: (search for simvastatin, atorvastatin, rosuvastatin etc). (Side effects and Forum) and (search for statins).

  5. Hedley 7 June 2014 at 8:52 am #

    After being diagnosed with type 2 diabetes, and having suffered chest pains, I was placed on the metformin and simvastatin route. While my HBA1C came down, as did my ‘high’ cholesterol, I felt dreadful – as if I’d been coshed. No energy, inability to focus or think, lethargic and impotent, all despite a Dr Briffa diet

    After two years of increasing doses I decided enough was enough. No one seem bothered to examine me – prescriptions were always on the basis of the latest blood test print-out.

    A friend who is a (quite renowned) naturopath spent well over an hour checking me over and concluded that the core of my problem was inflammation caused by wheat intolerance.
    Some vibrational healing treatment, plus acupuncture and self administered acupressure has restored my well being. Now 66 I can again trot up four flights of stairs with two bags of shopping. No chest pains, eyesight improved plenty of stamina, and impotence disappeared.

    I occasionally receive letters from the surgery telling me my health is at risk if I do not come in for my prescriptions. Really? My health was undermined by their myopia.

    Dr Briffa gave me the courage to be proactive in caring for my health, for which I thank him.

  6. Roger 7 June 2014 at 10:01 pm #

    My doctor has been suggesting statins for over a year now and I just politely suggest that I would not be taking them in any circumstances. As Jennifer suggests I will not be in the statisitics either and will be unaccounted for, unlike my friend who had a lot of joint pain until he came off them.

    Having just read “The Great Cholesterol Con” by Dr Malcolm Kendrick (a very informative well researched and amusing if the subject wasn’t so serious book) and following Dr Briffa’s informative and common sense newsletters it seems more and more obvious that we are all being taken for mugs by the drugs industry to help line their pockets.

  7. Janet B 11 June 2014 at 8:27 am #

    Interesting breaking news this morning on the subject of overprescribing of statins.
    Well, well, well. Who would have thought it? Are we on the verge of an epidemic of common sense and TRUTH at last.

    • David 11 June 2014 at 5:11 pm #

      At the moment the dark side seems to be winning. The Toady programme was interesting especially when Matt Baker of NICE was challenged about conflicts of interest, though he admitted he hadn’t seen much of the data he was basing his guidelines on.

      • Dr John Briffa 11 June 2014 at 6:03 pm #

        “Matt Baker of NICE was challenged about conflicts of interest, though he admitted he hadn’t seen much of the data he was basing his guidelines on”

        Yes, I listened to that bit about not having all the data and smiled when the interviewer seemed utterly incredulous (and so should she have been).

        On conflicts of interest, apparently the committee members can’t take industry money for a (whole) year before they start work but are free to resume straight after. So, that’s alright then.

        What got me was the righteous indignation of Professor Baker when the charge of conflicts of interest was put to him, making out it was a non-issue and utterly specious. I wonder how many Radio 4 listeners felt some credibility haemorrhaged out of Professor Baker at that moment.

Leave a Reply