Senior GP questions 'contradictory' NICE statin drive

NICE's plan to widen statin use to millions more patients is 'contradictory' and may require low-dose statins to be reclassified as over-the-counter medicines to avoid serious impact on GP workload, a GPC figure has warned.

Dr Andrew Green: critical of NICE statin stance
Dr Andrew Green: critical of NICE statin stance

Dr Andrew Green, chairman of the GPC’s clinical and prescribing subcommittee, questioned whether statins should be made available without a prescription if NICE deems them safe enough to be used preventively among healthy patients.

Prescribing the drugs to millions more patients as proposed by NICE could compound workload pressures on the profession by raising consultation rates, he said.

He warned this would also draw resources towards the healthy and away from the sick.

It follows draft NICE guidance to expand the prescription of statins to all 40-74 year olds with a 10% risk of cardiovascular disease within 10 years, lowering the threshold from the 20% level used at present.

Dr Green said: ‘We know that for primary prevention of cardiovascular disease the majority of statin patients derive no individual benefit from treatment, and if thresholds are reduced the likelihood of personal benefit also becomes less. At low benefit levels the importance of common, mild or rare severe adverse effects become more relevant.’

He added: ‘There is a contradiction here that needs to be addressed. If NICE are saying these drugs are so safe and effective that they can be taken by people who are not only healthy, but in fact may well be more healthy than their peers, it would seem odd that the regulations then say they are so dangerous that they can only be made available on prescription.’

By turning many healthy people into patients by prescribing them statins, ‘it might well compound the workload effects that GPs will encounter’, he said.

‘In an NHS with a finite number of GP appointments available we could again see the healthy taking resources from the sick.’

He said it was possible that the reclassification of statins for primary prevention may address some of these issues. ‘People could then make a choice on the basis of their own attitude to risk and intervention, because ultimately such decisions are made on philosophical rather than medical grounds.'

NICE is currently consulting on the guidance until 26 March.

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