KEY POINTS:
Every man over 50 should be offered a pill to cut his risk of a heart attack, the British Government's heart czar said yesterday.
Mass medication of the population would be the best way of cutting Britain's high death rate from cardiovascular disease which claims over 200,000 lives a year, Roger Boyle said.
But the National Director for Heart Disease acknowledged that the public was not yet ready to accept such an approach which would turn millions of "healthy" people into patients and draw accusations of a nanny state.
He called for a public debate on the pros and cons of "medicalising" the population by treating millions more people with statins, drugs to reduce cholesterol, which are already saving thousands of lives. For women, whose risk is lower, treatment would be offered at age 60, he suggested.
Statins have been described as wonder drugs, because they can reduce the risk of a heart attack or stroke by a third, if the dose used is high enough, and have few side effects. Three million patients are taking statins in England which are preventing an estimated 10,000 deaths a year at a cost of 550 million pounds.
The number is set to double to six million patients under new guidance lowering the threshold for treatment published by the National Institute for Clinical Excellence (NICE) in June.
Dr Boyle, who takes a statin himself - "the cheapest available" - said that since the mid 1990s when Britain was the heart disease capital of the world the death rate had fallen by 36 per cent, thanks in part to increased use of statins.
"It is not perfect yet but we have seen substantial improvement. We now need to move on. Despite the reduction in the death rate, cardiovascular disease is still the main cause of death, more than for all cancers combined. We have still got a huge task. We may no longer be the cardiovascular disease capital of the world but in a nation such as ours we ought to be achieving optimal results."
Current advice was to offer treatment to anyone with a 20 per cent increased risk of a heart attack over the next 10 years, based on their cholesterol level, blood pressure, weight, smoking and family history.
This involved a huge amount of time and effort by GPs and nurses involved in identifying, interviewing and testing patients at high risk.
"You could say once a man reaches the age of 50 he should be offered treatment, because the risk rises at over 50. But I don't think the general public is ready for a get-to-50-and-take-your-tablet approach. At the moment we need to do it on an individualised basis because that is what the public wants.
"I think it would have a bigger impact if we went for a blanket approach and we could get there with less hard work for the NHS. But we would get accused of running a nanny state and individualised treatment and choice is important to people."
Statins block the manufacture of cholesterol in the liver, lowering the level in the blood and cutting the risk of a heart attack or stroke. The biggest effect is in patients with the biggest reduction in cholesterol, regardless of their starting level - so potentially they could be effective in everyone.
Dr Boyle's remarks, at a briefing on statins, were rejected by Professor Peter Weissberg, medical director of the British Heart Foundation.
"I don't think [the blanket approach] is the right approach at this stage. It may be right in 10 - 15 years when we know more about statins. I have always taken a cautious approach to prescribing.
"The downside with statins is as low as any drug I have seen, but there is still a downside."
- INDEPENDENT
