Cheapest but Least Effective

The UK national threshold for preventing heart disease with cholesterol lowering statins is much cheaper, but also much less effective, than either US or European recommendations, finds research published ahead of print in Heart.

The National Health Service Framework (NSF) on heart disease also makes the least effective use of the available evidence on what works best, say the researchers.

The research team compared national, European, and US recommendations on the primary prevention of cardiovascular disease in middle aged men, using cholesterol lowering statin drugs.

They applied these recommendations to 1653 men between the ages of 49 and 65, who were taking part in the Caerphilly Prospective Study.

In particular, they looked at who would be eligible for treatment, the number needed to treat in order to prevent one first serious episode of disease, such as a heart attack or stroke over 10 years.

And they also looked at the potential number of serious disease episodes prevented in the population as a whole, as a result of treatment with statins.

Over the 10 years there were 212 heart attacks or stroke among the men. To cut the rate of heart attack or stroke by 30% would require 26 men to be treated for every episode prevented. But this would mean treating the whole population.

The NSF recommendations target those at highest risk, so require just 12 people to be treated.

But this only cuts the rate of heart attack or stroke in the overall population by 9%, which is the lowest preventive impact of all the recommendations.

The US and European recommendations require 21 men to be treated, but cut the overall rate by around 23%. However, 60% of middle aged men in the population would have to be given statins.

New joint British recommendations aligned with a recent assessment of the value of statin treatment in coronary and stroke prevention by the National Institute of Health and Clinical Excellence cut the rate of heart disease or stroke by 27%.

But these require 22 men to be treated for every episode prevented, and would mean that 75% of middle aged men would have to be given statins.

The authors conclude that statin treatment will make little difference to the overall rate of cardiovascular disease unless it is targeted at all those at average risk. This means targeting most men from middle age onwards and most older women, they say.

"Whether cholesterol lowering on such a scale should be attempted with drugs raises philosophical, psychological, and economic considerations," they comment.

More effective national policies on nutrition to reduce reliance on statins should also be considered, they suggest, highlighting a "lack of resolve in tackling Britain's unhealthy diet," which has led to one in three of Europe's obese children being British.