Switching patients from 10 or 20mg atorvastatin (Lipitor) to 40mg simvastatin could save the NHS in England more than £2 billion over five years, say the researchers.
Their estimates are based on the 5.2 million people who will need statins under NICE guidance that targets those with a 20 per cent or higher 10-year risk of cardiovascular events.
About 85 per cent of statin prescriptions in England are for simvastatin or atorvastatin. Most atorvastatin doses are at 20mg or less daily.
At these doses 'the effects of the drugs are identical', said Dr Richard Bogle, cardiologist and clinical pharmacologist at Hammersmith Hospital, who wrote a BMJ editorial advising a switch to simvastatin 40mg.
Dr Graham Archard, RCGP vice-chairman, said that patients should always be started on simvastatin 40mg but moved to atorvastatin if cholesterol was not lowered sufficiently. Simvastatin should not be used at doses higher than 40mg daily because of side-effects, he added.
BMJ 2006; 332: 1,344-5
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