Good drugs may be bad for you!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
walkin on 2006-05-10
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