Statins should not be considered as a stand-alone wonder-drug in the fight against heart disease

May 17 2004

Dr John Reid, the Health Secretary for the United Kingdom (UK), announced the reclassification of statins as ‘over the counter’ products in the UK, to be available to members of the public directly from pharmacists without the need for a prescription.  With this move, recently approved by the UK’s Committee on Safety of Medicines, the UK is the first country to move a statin from prescription-only to over the counter access. 

The initial statin to be available from pharmacists will be simvastatin, at a daily dosage of 10mg.  Simvastatin will be targeted at individuals with a low to moderate risk of heart disease, specifically sub-populations such as men aged 50 years and over and women aged 55 and over with one or more risk factors including: obesity, cigarette smoking, insufficient physical exercise, unhealthy diet, hypertension, diabetes or family history of heart disease.  An on-the-spot blood test is envisaged to assess if an individual requesting simvastatin is eligible and if the results are positive the treatment can be purchased immediately.

As a result of this decision, UK health authorities expect to increase the usage of statins in primary prevention, in order to reduce cholesterol levels in the UK population and ultimately reduce the country’s high incidence of heart disease, arguing that the move is in favour of improving patient choice and access to medicines.

Statins not a stand-alone prevention measure

In light of this development, the European Society of Cardiology (ESC) stresses the importance of viewing statins appropriately within the global risk management environment. 

Simvastatin, along with the other statins in its class, is a very effective treatment option in both primary and secondary cardiovascular disease prevention.  However, it is by no means a substitute for lifestyle factor improvements and should only be taken in parallel to effective risk factor reduction methods such as healthier eating, increased exercise and refraining from smoking.

Professor Bassand, ESC President, outlines, “The ESC is a strong exponent of global risk management.  Lifestyle factors and the promotion of healthy living are crucial to cardiovascular disease prevention.  Whilst statins, such as simvastatin, are extremely effective in reducing the risk of heart disease, it is crucial that a global approach is taken and efforts are made to reduce risk factors on all levels.  Patients must be adequately encouraged to improve their lifestyles to lower their heart disease risk and not misperceive the taking of a statin as a stand-alone risk reduction option”.

Screening and monitoring are crucial

Professor Bassand continues, “It is important that pharmacists are fully briefed in order to ensure that individuals take the treatment as recommended, regularly and with an appreciation of the need to report side effects.  Blood cholesterol and other risk factors, such as family history of heart disease, should be noted and taken into account not only before but also during treatment, and individuals should also be advised on how to improve their lifestyles to reduce their risk profile overall”.

Prevention is a priority

Professor Bassand states, “The mission of the ESC is ‘to improve the quality of life of the European population by reducing the impact of cardiovascular disease’, and prevention is one of the most important means by which this can be achieved.  The ESC acknowledges the UK ruling as placing cardiovascular disease prevention high on the healthcare agenda.  This should be coupled with increased emphases on lifestyle factor improvements, healthy living campaigns and specific targets for individuals to strive for”.

Professor Bassand continues, “Statins are notoriously under-prescribed and any initiative to improve access to at-risk populations is a step in the right direction, provided that these individuals are appropriately screened and monitored and made equally aware of the need for risk factor reduction overall”. 

“Statins should not be considered as a stand-alone wonder-drug in the fight against heart disease.  Individuals should be encouraged to reduce their cholesterol and other risk factor levels through lifestyle improvements and actively supported to do so with on-going public health campaigns”, concludes Professor Bassand. http://www.escardio.org