In 2013 the ABC Catalyst program stirred the statins pot. What was that really all about?
With 2.1m Australians taking statins in 2011-12, and three statins in the ‘top 10’ of dispensed drugs in 2010 at a PBS cost of $1.25b that year, there were many market forces at play when the ABC ran its two part series the Heart of the Matter – Cholesterol Drug Wars in October 2013. These programs suggested, amongst other things, that statins were overprescribed. After considerable protests, the ABC’s independent Audience and Consumer Affairs Unit acknowledged contrasting expert opinions but supported the accuracy of reporting, while accepting that Part 2 was not impartial. With some water under the bridge, we have got out our retrospectoscope.
Where does the NPS sit?
In June 2013, the NPS’s Australian Prescriber published an article, Statins in Older Adults, in which it said use of statins in people over age 65 was high (reportedly 40%), and:
• CVS risk from cholesterol decreases with age (and inversely relates to stroke risk).
• For those aged 65-82 with coronary artery disease, you need to treat 28 people for five years to save one life.
• Primary prevention with statins for CVS disease in older people is uncertain. Any benefit accrues over five years – no better than placebo in the first year – so the person’s lifespan is important.
• Statins in people with CVS disease probably decrease recurrent ischaemic stroke but increase haemorrhagic stroke.
• Statins do not help people with dementia and withdrawal in Alzheimer’s patients improves cognitive function.
They pointed to dose effects – 80% of lipid lowering effect occurs at half the maximal recommended dose. The risk of adverse effects of muscle symptoms over age 70 increases as does diabetes risk especially at higher doses.
In summary, the article said increased side effects and co-morbidities make statins a line-ball treatment in the elderly, particularly as circumstances change and frailty increases. In response to following letters, the authors pointed out that most of their conclusions applied to fit elderly people as those with increased frailty were often excluded through co-morbidity, co-medication or impaired physical or cognitive function.
Three months after Catalyst, the NPS consumer online publication Medicine Wise under the headline, Keep Taking Your Statins Benefits Outweigh Risks, said that consumers should ignore mainstream media reports that statins were overprescribed and only act if their doctor advised against statins. That is, if the alleged overprescriber suggests you continue with the drug, follow this advice!
We could find nothing more on statin prescribing since from the NPS, which has a clear consumer focus.
On December 11 2013 the Heart Foundation waded in with an online publication of its survey of 1094 Australians who had been taking statins for at least three months. About 25% had seen their GP or health professional to discuss use of statins. About 22% had reduced their medication adherence, whether temporarily, and about 5% had done this with a history of a pervious heart event. A reported 9% had stopped statins since watching, reading or hearing about the show.
The CEO’s concern was around the 5% who might be at risk of another heart attack or stroke and might not survive. Then followed statements like “statins are life-saving” and “high risk patients who’ve stopped their medication”, concluding there are “potentially 55,000 Australians who have stopped their medication as a direct result of the catalyst programs”.
Not to let the facts get in way of a good story, Cathy O’Leary at The West Australian wrote the same day that 55,000 had stopped their statins, which could cause 2000 heart attacks and strokes. A noticeable point in the piece was that half had not consulted their GP when stopping their medication.
Why would they if they thought their GP was needlessly prescribing statins in the first place? Food for thought?
And what of lifestyle factors? In the Heart Foundation survey, 41% of respondents were obese, and 22% were smokers but 27% had increased exercise and 24% had changed their diet since the program. More food for thought?
Epoll – 124 GPs gave us their opinion in early 2014
Do you believe statins are overprescribed in the elderly?
Yes 54%
No 22%
Uncertain 24%
Which of these online sources would you recommend as balanced independent advice for health consumers on the need for statin use [multiple choice]?
National Prescribing Service 39%
RACGP 28%
AMA 17%
Wikipedia 4%
Google scholar 4%
Other: 9%
Peter KortPeter Kort’s story
Peter Kort is a 66 year-old male, with high cholesterol and Type II Diabetes. His doctor prescribed Lipitor three years ago and the side-effects weren’t pleasant. Peter had also heard that statins weren’t too good for ‘Mr Wriggly’ and he wasn’t happy about that either. And he was also distinctly unimpressed with the lack of informed advice coming from his doctors.
“I didn’t know what was happening. I had constant pain in my legs, I was always tired and just couldn’t get comfortable in bed. My haematologist, GP and the doctor I go to for testosterone injections didn’t say anything about statins, even when I told them about the problems I was having.”
“The doctor I see for my sexual health told me that it ‘wasn’t his area’ and his main concern was to make sure that Mr Wriggly stays alive.”
“I went to Europe for a holiday and when I told my mother-in-law how I was feeling she said, ‘it’s probably the statins’. I went on to Google and stopped taking Lipitor immediately. I told my GP when I came back to Perth, he sent me for a cholesterol test and he hasn’t got back to me so everything must be okay.”
“I’m on Metformin now and feeling a lot better. I don’t need to go for a ‘nanna-nap’ these days!”