Good drugs bad for you.

[Guest guest]

Success of heart drugs masks cause of disease

· Call to tackle underlying factors of biggest killer

 

· 30m prescriptions for statins cost NHS £769m

Wednesday May 10, 2006

Britain is becoming a nation of pill takers,

increasingly reliant on drugs to counter its biggest

killer, heart disease, rather than tackling the

underlying lifestyle causes like obesity and smoking,

according to figures released today.

Thirty million prescriptions for cholesterol-lowering

drugs, statins, were written in 2004 - one every

second of the day - the British Heart Foundation's

annual statistical compendium reveals. The bill to the

NHS was £769m and is rapidly rising, while the number

of prescriptions is 17 times the level 10 years ago

and has doubled since 2001.The foundation, which

helped to fund the research into the drugs, says the

increased use of statins has prevented thousands of

deaths from heart attacks and strokes, with a 7% drop

in heart related fatalities in 2004.

Other heart drugs - there are now 200m prescriptions

in total a year - and more frequent angioplasties and

heart bypass operations have also helped to bring the

total of deaths down. But according to the BHF's

figures, 105,842 people still died of heart related

disease in 2004, and a third of those were premature

deaths under the age of 75.

" The message from the statistics that we have is that

we have become pretty good at managing the disease

when we know it's there, " said Peter Weissberg, BHF

medical director. " Fewer people die when they have a

heart attack. The problem is that we have done nothing

yet really to prevent the disease occurring in the

first place. "

While those at risk of heart disease seem happy to

take their medicines, there is little evidence that

they are motivated to tackle the unhealthy lifestyle

that is the cause of their life-threatening disease.

The BHF estimates that at the current rate of

progress, it will take 50 years before adults in the

UK reach the government's target of eating five

portions of fruit and vegetables a day.

Only a third of men and a quarter of women take the

recommended level of exercise - at least 30 minutes,

five days a week. The UK has the fifth most obese

population in Europe. In less than 20 years, the

number of overweight or obese men in England increased

from 45% to 67% and the number of women from 36% to

59%. " A big concern we have is that the group of

people most likely to die are the overweight who get

type 2 diabetes, and sitting in the wings is a huge

population of youngsters who are overweight and likely

to get type 2 diabetes, " said Professor Weissberg.

Type 2 diabetes leads to heart disease. Since the

1970s the trend in heart disease deaths has been

steadily downwards. That could change, he said. " Over

the next decade we may start to see the curve climb up

again with this cohort of younger people with diabetes

and cardiovascular disease. " The heart problems in

today's obese teenagers could kick in within 10 years.

Statins have cut the risk of a heart attack by 30% in

trials, but they are not the whole answer. " The fact

is that we still end up with people with heart attacks

on statins. The best way to avoid heart attacks is not

to get the heart disease that causes it in the first

place, " he said. The BHF says the government and the

food industry need to do more. It says it is

disappointed that efforts to make food labelling

clearer and restrict junk food advertising to children

have been " so undermined by some in the food

industry " .

Few doubt the benefits of statins for people at high

risk of heart disease or who have already had a heart

attack or stroke. But many take issue with the

government's strategy to allow high street chemists to

sell them to the public. The Department of Health says

it has no idea how many people are taking the low-dose

statin called Zocor Heart-Pro, which was given a

licence for pharmacy sale. Graham Jackson, consultant

cardiologist and editor of the International Journal

of Clinical Practice, described the exercise as " one

huge experiment " in which the public were guinea pigs.

" The reason I'm not - and a huge number of people as

well are not - happy is because you don't know the

profile you are dealing with, " said Dr Jackson. " You

could be giving them strong medication without any

real indication that they need it. " Pharmacists are

supposed to give patients cholesterol tests, but the

needleprick sort they administer is " totally

inaccurate " , said Dr Jackson. A doctor would measure

the levels of different types of cholesterol, as well

as triglycerides, in the blood, and then set targets

for reducing them with appropriate drug treatment.

There is no long-term data on the effectiveness of

giving people statins through a pharmacy. " These are

not Smarties. They do have side-effects, " Dr Jackson

said. " While they are thankfully low, they are

present. " The commonest are muscular aches and pains.

One high dose statin, called Baycol, was taken off the

market because of the numbers of people developing a

serious condition involving muscle breakdown. Ike

Iheanacho, editor of the Drug and Therapeutics

Bulletin, said the promotion of statins could send

confused messages to the public. " The way the message

is often presented in terms of the wonder drug is very

glamorous compared to the one about eating a healthy

diet and taking regular exercise and stopping

smoking, " he said.

At a glance

· Coronary heart disease costs the healthcare system

around £3.5bn a year, according to the British Heart

Foundation. Most of this is the cost of hospital care

for people with heart attacks and strokes and

treatments such as bypass operations. Drug costs are a

significant part of the bill, though, at 16%

· Death rates have been falling in the UK, but not as

fast as in some other countries. Deaths in men aged

35-74 fell by 42% between 1990 and 2000 in the UK, but

by 54% in Norway and 48% in Australia

· Smoking causes more than 30,000 deaths a year from

heart disease, it is estimated

· Declining physical activity is a cause of rising

heart disease. Since the mid-1970s the average number

of miles per person travelled on foot each year has

dropped by around a quarter and by bike by around a

third

· Coronary heart disease causes more than 105,000

deaths a year, approximately 21% of all male deaths

and 15% of those in women