Written in Sydney Morning Herald
March 1, 2012
THOUSANDS of Australians could be taken off cholesterol-lowering medications because of mounting evidence they increase the risk of diabetes and dementia.
Australian health authorities are reviewing their advice after US regulators announced statins will now carry warnings they could increase the risk of diabetes and cognitive impairment.
Statins are the most commonly prescribed drugs in Australia, with about 2 million people thought to be taking them to reduce their heart disease risk.
The president of the Australasian Society for Clinical and Experimental Pharmacologists and Toxicologists, David Le Couteur, said Australia had one of the highest rates of statin use in the world, and people who were not at high risk of heart disease needed to reconsider using them.
He said doctors and other health practitioners should focus on lifestyle interventions for people with high cholesterol but without other risks such as previous heart attacks, high blood pressure and smoking.
Despite statins being linked to diabetes, he said people with the condition should still use them as diabetes itself put them at risk of heart disease. “If you have diabetes that’s even more reason to be on statins,” he said.
Statins have long been touted as a miracle drug, with some doctors and researchers pushing for their use in all older people. But Professor Le Couteur said that was unwise. “Unfortunately the history of medicine is chequered with hopes that have turned out to be dashed and even caused harm,” he said.
The evidence showing a link with cognitive impairment was not as strong as the links with diabetes, but if a patient developed symptoms he would consider taking them off the drugs.
But the director of the Baker IDI Heart and Diabetes Institute, Garry Jennings, said people should not stop taking statins.
“I hope that pretty much everyone who is on a statin in Australia is on it for a very good reason, although there might be a few lower-risk people on the fringe,” he said. “Statins work and there have been tens of thousands of people in trials … the overall benefit is clear.”
About 500 people would need to take statins for one new case of diabetes to develop, while a major cardiac event would be prevented for every 150 people taking them.
The national director of clinical issues for the Heart Foundation, Robert Grenfell, said he was more concerned by the number of people at high risk of heart disease who were not taking preventive medication. “We still have a high rate of morbidity and mortality from heart disease in this country,” he said.
A University of NSW professor of clinical pharmacology, Ric Day, said there was no doubt a lot of Australians had been prescribed statins when their total risk of heart disease was not high. “It’s a bit of a pity because you are taking a drug that doesn’t contribute much to your protection at all,” he said.
A study by the National Prescribing Service found the use of lipid-lowering drugs such as statins had increased from 4.8 per cent of people aged 45 and over in 1995, to more than 30 per cent.
The chief executive of the service, Lynn Weekes, said Australia’s high use of statins compared to the OECD indicated it was likely low-risk people were being treated. “If they are at low risk of heart disease you shouldn’t be putting them at risk for something else,” she said.
A spokeswoman for the Therapeutic Goods Administration said it was considering whether any action is required in Australia.