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Drugs for all?

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Should everyone over the age of 55 be taking a cholesterol lowering drug to lower their long term risk of heart disease, or should be remembering the old saying ‘if it aint broke, don’t fix it’?

Just the day after my aforementioned relative1 came home having taken the decision to stop taking the drug prescribed for prevention he deemed unnecessary, this is the advice of the latest study, being reported on the BBC evening news.2

Would the ‘drugs for all’ approach be simpler and more cost effective? I don’t know. Is there really any way of finding this out? The research in question seems to have been carried out using a statistical model, but are its findings translatable to real life? And have we forgotten to account for the patients? As suggested, will distributing lipid lowering and anti-hypertensive medication left, right and centre really avoid the need for blood tests and medical examinations thus making the health service more cost-effective? I’m doubtful, since we absolutely can’t take age as our only measure of risk.

Age is certainly a major risk factor for death. But how can we say that tackling age as our major risk factor will solve all of our problems, whilst discarding the central issue of health promotion; healthy diet, exercise and smoking cessation have a far greater role to play than this study seems to consider.

Men with a south Asian background have an increased cardiovascular risk by a factor of 1.4. It might even be perceived sexist or racist to offer cholesterol lowering drugs as a matter of course just to this patient group. Equally should we be dishing out preventive meds to those with a family history of heart attacks and strokes?

What gives people the impression that the general public will be up for taking drugs they don’t need? What about those (statistically there will be some) who won’t benefit in the long term from taking preventive medication but may well experience side effects and complications associated with it? Even if there is a need I recognise, will my patients recognise their perceived need and if they get as far as the pharmacy what can be said for their compliance?

What do others in the field think? Could you (or your relatives and friends) be convinced at age 55 to start taking tablets every day or would you do better to eat well and run around the block?
Maybe statins for all over 55s could lower their long-term risk of heart disease, but perhaps we should be reminded, ‘if it aint broke, don’t fix it’. 

 

1.      (see blog post ‘More Harm than Good’ for more on the Statin debate)  

2.      http://www.bbc.co.uk/news/health-13284032

 

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