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Statins often prescribed without good evidence

By Genevra Pittman

NEW YORK (Reuters Health) - 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 percent 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 percent to 94 percent.

‘TRIGGER HAPPY'

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 percent 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," Messerli, who was not involved in the new research, told Reuters Health.

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 Monday in JAMA Internal Medicine.

About one-quarter of adults age 45 and older in the U.S. 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 told Reuters Health 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' benefits.

"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.

SOURCE: http://bit.ly/KEPNSw JAMA Internal Medicine, online March 11, 2013.

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