London School of Hygiene & Tropical Medicine

According to Professor Shah Ebrahim and Dr Juan-Pablo Casas, the study by the Cholesterol Treatment Trialists (CTT) published in The Lancet confirms the efficacy of statins for prevention of cardiovascular disease in people without previous cardiovascular disease and resolves concerns about possible serious side effects. It finds that statins reduce the risk of major vascular events (heart attacks/strokes/coronary artery surgery) by 20% in people of low to high risk of CVD and suggests that treatment guidelines might need to be reconsidered.

The current threshold for statins prescription is a 10-year CVD risk of at least 20% - this applies to half of men over 50 and 30% of women over 60 in England. In an accompanying Commentary in The Lancet, Professor Ebrahim and Dr Casas point out that if the threshold was lowered to 10% based on the findings of the study, 83% of men over 50 and 56% of women over 60 would be classified as needing a statin.

Professor Ebrahim, Professor of Public Health at the School, said: “This research provides further evidence that statins are an effective and safe way of reducing the risk of heart attacks and strokes even among people at quite low risk of these conditions. 

“But it also raises a number of important questions for the NHS and clinical practice.

“If we were to go down the road of prescribing statins to everyone there is  a risk that doctors’ attention may not focus on high-risk groups who would benefit most in absolute terms from statins – and in whom under use of statins is still far too common.

“However, the benefits of giving statins to everyone over the age of 50 would probably save the NHS money in the long run, owing to the savings in health care costs from the heart attacks and strokes prevented.

“Whether populations will be well-served by our current pharmacologically dominated research findings for lifestyle related diseases is debatable. I would argue that politicians should also include health outcomes in their decision making about trade, agriculture, urban planning, beverage and food policy.”