Many doctors prescribe statins to people who have little chance of benefiting
from the cholesterol-lowering drugs, a new study suggests.
In a survey of 202 primary care doctors and cardiologists, more than 70% said
they would prescribe a statin to patients who have a very low chance of
developing heart disease during the next decade, based on their cholesterol and
blood pressure levels and other risk factors.
"With patients who don't have heart disease, talking to their doctor about
the risks and benefits of (statins) as well as alternative treatments and ways
to change lifestyle is going to be important," said Dr Michael Johansen, who led
the new study at the University of Michigan in Ann Arbor.
He and his colleagues sent anonymous surveys to 750 randomly-selected doctors
across the country who treat people with high cholesterol. Those surveys
included six clinical vignettes describing hypothetical patients of different
ages - from 40 to 75 - and genders.
None of those made-up patients had heart disease.
They varied in their LDL (bad) cholesterol levels and whether they had high
blood pressure or diabetes or smoked.
Of the less than one-third of doctors who responded to the survey, the
proportion who said they would prescribe a statin to each hypothetical patient
varied from 40% to 94%.
Among the three people who were deemed to have a very low risk of heart
disease - for example, a 40-year-old man with high cholesterol and
well-controlled hypertension - doctors said they would prescribe statins 73% to
89% of the time.
"We have to consider that the downside in the minds of the physicians is
usually fairly low," said Dr Franz Messerli, who runs the hypertension program
at St Luke's-Roosevelt Hospital in New York City.
"Many physicians are trigger happy, and do just prescribe a statin, which
obviously is not necessarily correct," said Messerli, who was not involved in
the new research.
The one patient for whom less than half of doctors said they would prescribe
a statin - a 55-year-old woman with diabetes and low LDL - would likely benefit
from the drugs due to her diabetes alone, the researchers wrote.
About one-quarter of adults age 45 and older in the US take statins. The
drugs run anywhere from $11 to more than $200 per month. Possible side effects
include muscle pain, nausea and gas and liver dysfunction.
Johansen and his colleagues say their findings suggest doctors aren't doing a
good enough job of considering a patient's heart risks when deciding whether to
prescribe a statin.
Although the survey didn't ask participants why they would make a particular
treatment decision, Johansen said doctors may get caught up focusing on a
patient's LDL levels.
"It seems like people could be treating more of a number than a patient's
risk," he said.
Messerli also pointed to the heavy direct-to-consumer advertising around
statins and how some of those ads are quite misleading about the medications'
"Physicians are under pressure from their patients," he said. Some people who
don't really need a statin may want one they saw on television. \
Others with diabetes and low cholesterol may not see the point of a statin or
may want to avoid taking another drug, Messerli added.
"The whole issue is not a simple one," he said.