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Sunday 7 June 2015

Viewpoint: Dr Kailash Chand: NICE QOF statins decision is flawed

It is unfortunate that NICE continues to press for the threshold for starting treatment to prevent cardiovascular disease to be halved from a 20% risk of developing cardiovascular disease over 10 years to a 10% risk, writes Dr Kailash Chand in a personal capacity.

NICE describes itself as providing ‘independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health’.

The medical profession should therefore expect NICE to base its findings on full data disclosure and independently evaluated cost-benefit of statins. Simply asserting that it is independent seems unconvincing.

I believe such guidance would not have the confidence of the majority of GPs charged with its implementation. In May 2014 the LMCs conference passed a unanimous motion calling for NICE to recommend such changes only on the basis of a full disclosure of trial data.

I developed side-effects
Before retiring I was a GP for more than 30 years and prescribed statins with little concern, until I took statins myself for over two years. I developed side-effects including myalgia, backache and sleep disturbance. I stopped taking statins and my symptoms largely disappeared. An intervention trial evaluating rosuvastatinrevealed that one in 100 women taking a statin risked developing type-2 diabetes at 1.9 years. For these individuals the chance of contracting diabetes is roughly the same as the chance of avoiding a non-fatal heart attack. For those with a low risk of cardiovascular disease,130 people need to take statins for a year to prevent just one unwanted health outcome.
At present, it is estimated that approximately 7 million people in the UK take statins. If NICE guidance is followed the number could increase by several million. The evidence for the benefit in primary prevention – ie preventing cardiovascular disease in people who do not have any diagnosed cardiovascular disease – is weak. The side-effect data has been declared commercially out of bounds, leaving medics and patients unable to evaluate the cost-benefit of these drugs.
Now imagine the costs and workload of follow-up appointments and hospital investigations that patients experiencing such side effects could incur.
Perhaps more worryingly, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organisation, 80% of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people who would be much better served, for example, by simply walking an extra 10 minutes per day, and avoiding processed food.
This does not mean that statins should be stopped for patients who are currently taking them and have shown benefits. It’s about statins being used appropriately, in the treatment and secondary prevention of cardiovascular disease. Patients should be sceptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them. Good medicine should always be evidence based and given to the right patient at the right time.
I have tremendous respect for NICE, but, in my personal view this recommendation is flawed. I urge NICE to reconsider its position. Instead of converting millions of people into statin users, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise, and avoiding smoking.
  • Dr Chand is BMA deputy chairman but is writing in a personal capacity.

I think hoping for a full disclosure of statin trial data is wishful thinking, with many of the panel who put together NICE guidelines having links to Big Pharma they are hardly likely to comply.



Launna said...

I wish that drs would recommend eating healthy and exercising more strongly... I think they quicky suggest pills too often. Maybe if they talked more about the side effects from the pills... people might think twice. It is a lifestyle change but so worth it, it was the best choice I ever made ;-)

Lowcarb team member said...

Hello Launna and thanks for your comment. I do agree "a lifestyle change" can and does make such a difference.

All the best Jan