The latest research findings suggest that when assessing the risk of heart problems, offering statins or drugs that lower cholesterol to all over-55s had the same results as testing for cholesterol or blood pressure problems. The authors have also argued it would be simpler and more cost effective.
Current guidelines recommend that decisions to prescribe statins or blood pressure treatments for people at cardiovascular risk are based on a combination of multiple risk factors including age, sex, smoking, diabetes, serum cholesterol and blood pressure. This comes from a study that compared screening people for treatment using this method with treating all people over 55. The findings suggest that both approaches perform at about the same accuracy and are similarly useful in preventing heart disease and stroke.
The study was carried out by researchers from the Wolfson Institute of Preventive Medicine in London. The authors have no support or funding to report. The study was published in the peer-reviewed medical journal PLoS ONE.
The model was of a hypothetical population of 500,000 people up to 89 years of age, whose 10-year risk of having a cardiovascular disease (CVD) event was either estimated according to their age, or through a calculation known as the Framingham risk equation. The researchers said that out of all of the factors taken into account in the Framingham risk equations, age has the greatest influence on a person’s subsequent risk of CVD. They suggested that using age alone may be a simpler screening strategy to decide which people need treatments that could prevent the onset of CVD.
Results showed that both strategies had a maximum 84% detection rate, meaning that among those people who went on to develop heart disease or stroke over 10 years, 84% were correctly identified.
The researchers say that offering everyone preventive treatment at the age of 55 would also be more cost effective. The estimated cost for each year of life free of heart disease or stroke gained was £2,000 for age screening and £2,200 for Framingham screening. These results were calculated assuming that a Framingham screen costs £150 and the annual cost of preventive treatment is £200. Age screening using a cut-off of 55 years detected 86% of all first CVD events arising in the population every year.
Researchers conclude that age screening for future heart disease or stroke is simpler than Framingham screening as it avoids the blood tests and medical examinations that the Framingham assessment requires. The researchers also say that the age cut-off of 55 could be set lower for people with diabetes as they have an especially high vascular risk and will already be aware of this.
Natasha Stewart, senior cardiac nurse at the BHF said, “There’s not enough evidence that everyone of a certain age should be offered treatment, such as statins, without taking other risk factors into account. Also, it is essential that we continue full risk assessments for younger people who may be at significant risk of getting heart and circulatory disease.”
Professor Sir Nicholas Wald said prescribing cholesterol-busting statins and blood pressure pills based on age alone would be much easier and quicker than the current system. Patients would not be taking the drugs needlessly because almost everyone of a certain age could benefit from having lower blood pressure or cholesterol, no matter what level it is to begin with, Sir Nicholas said.
However, concerns about the side-effects of the drugs mean that the proposal would be controversial. It is also unclear whether people would be willing to take tablets when they have not had an examination to show there is anything wrong with them.
Sir Nicholas said, “This study shows that age screening for future cardiovascular disease is simpler than current assessments, with a similar screening performance and cost effectiveness…It also avoids the need for blood tests and medical examinations…Prevention is better than measurement. Identifying people at high risk of cardiovascular disease needs to be greatly simplified, enabling people to obtain easy access to preventive treatment.”
There are also worries that over-reliance on pills would lead to people neglecting other aspects of their health, such as diet and exercise. Addressing the concerns, Sir Nicholas said the benefits would easily outweigh the risks. But he cautioned that the policy would not be a panacea and that other health drives, including anti-obesity initiatives, would have to continue in parallel.
The British Heart Foundation said the approach would not help those under 55.
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