This article is part of our special report Cardiovascular health in the UK.
Statins are already the United Kingdom’s most commonly prescribed medicines – roughly 6 million Brits take the drugs on a regular basis to lower the risk of a cardiovascular incident, in line with US practice. But in continental Europe, views tend to differ.
Statin treatment is typically offered to patients who have had a heart attack or stroke to reduce their risk of a repeat incident.
But whether to increase the use of medication, which works to lower the level of cholesterol in blood, particularly in patients believed to be at potential risk of developing cardiovascular diseases (CVD), is one of the more controversial issues in medicine.
It is also an area where the UK and United States have taken a more aggressive stance than the rest of Europe.
In 2013, the UK’s National Institute for Health and Care Excellence (NICE) lowered the risk threshold above which prevention with statins should be considered, advising doctors to prescribe statins for patients with a 10% risk of heart disease over the next 10 years.
For its part, a review published this week by the United States Preventive Services Task Force, found that statins were associated with a 36% lower risk of heart attack and 29% lower risk of stroke compared with placebo in a review of data from more than 70,000 patients.
Lower threshold on the continent
However, the 2016 update of the guidelines issued by the European Society of Cardiology (ESC), retained a threshold of a 5% 10 year risk of fatal cardiovascular disease.
At the ESC’s annual congress in August, cardiologists said that the new guidelines emphasised lifestyle and nutrition alongside targets for body mass index and weight, while the ESC’s Task Force stated that around 80% of CVD instances could be prevented by behavioural changes.
Meanwhile, high-risk patients who do not have high cholesterol should not be prescribed statins, according to the ESC.
So which stance is correct?
A review in leading medical journal The Lancet in September argued that statins prevent around 80,000 heart attacks and strokes every year.
“Our review shows that the numbers of people who avoid heart attacks and strokes by taking statin therapy are very much larger than the numbers who have side-effects with it,” said author Professor Rory Collins from the University of Oxford.
“Whereas most of the side-effects can be reversed with no residual effects by stopping the statin, the effects of a heart attack or stroke not being prevented are irreversible and can be devastating,” he added.
“Controversy over the safety and efficacy of statins has harmed the health of potentially thousands of people in the UK,” adds Dr Richard Horton, editor-in-chief of The Lancet.
However, cardiologists have been waging a battle for several years in the pages of the publication and the statin-sceptic British Medical Journal for several years, with some physicians disagreeing about whether statins are appropriate for low-risk patients. Others point to side effects including the increased prevalence of Type 2 diabetes, memory loss and muscle damage.
Only part of the picture
Statin use is clearly only part of the picture. Despite its more aggressive stance on statin prescription, the UK ranked only 13th across the EU-28, according to the Euro Heart Index (EHI) published in December, which provides a ranking of cardiovascular healthcare systems in 30 countries.
France and Sweden ranked first and second. The EHI concluded that European healthcare systems suffered from a “prevention deficit”.
It is also unclear how effective statins are at preventing a first heart attack or stroke in people with cardiovascular disease (CVD) risk factors.
Even so, Professor Arne Björnberg, who chairs the Health Consumer Powerhouse, which publishes the EHI stated that, “more systematic use of therapies such as statins and clopidogrel would save thousands of lives”.
For the moment, however, there is little sign of the statin divide being bridged.
The number one killer in Europe, cardiovascular disease, is set to become an even greater burden on the already recession-hit continent's health systems.
Cardiovascular disease accounts for 52% of female deaths and 42% of male deaths in the EU. Approximately four million people in Europe and 1.9 million people in the EU die of cardiovascular disease each year, according to the European Society of Cardiology. Cardiovascular disease and strokes are usually caused by high levels of bad cholesterol, high blood pressure, obesity, unhealthy diet and physical inactivity.
The European Society for Cardiology (ESC) and the European Heart Network (EHN) estimate the cost to the EU economy at over €196 billion per year, with healthcare expenditure varying from 4% in Luxembourg to 17% in Estonia, Latvia and Poland.
To reduce the number of deaths from heart diseases, EU countries agreed in November 2013 to tackle the underlying health determinants behind cardiovascular disease in the common health programme for 2014-2020 through “promoting health, preventing diseases and fostering supportive environments for healthy lifestyles”.
The EU wants cost-effective prevention measures for addressing tobacco, alcohol, and unhealthy dietary habits. It also aims to promote physical activity among EU citizens.
Sanofi have provided the funding for this report. Sanofi have had no editorial input or involvement in the content of this report.