Primary prevention with over-the-counter statins: a cautionary tale (original) (raw)
Related papers
Health Risk & Society, 2019
Primary prevention of cardiovascular disease has been a site of medicalisation, as demonstrated by the significant increase in the use of cholesterol-lowering drugs, statins, over the last thirty years. While this is welcomed by many in the medical community, others have criticised the expansion of statin use to low-risk people. In the context of this debate, the aim of this article is to present a broad scoping review of the literature on how preventative health, risk and 'candidacy' for statin treatment are perceived and negotiated by clinicians and patients. We examine how evidence and knowledge about cardiovascular risk reduction is produced, interpreted and communicated and how patients' gender, socio-demographic and cultural differences may impact patterns of statin use. We found that few studies differentiated between the use of statins in those with and those without established cardiovascular disease, despite the fact that the majority of statin users, and women in particular, fall into the primary prevention category. In this context, the process of medicalisation is predicated on healthy individuals being subject to medical surveillance of risk factors, which have acquired the status of disease in their own right. Central to this process has been the heuristic that identifies elevated cholesterol as a medical problem warranting statin treatment, as well as the difficulties encountered by doctors and patients in understanding, interpreting and communicating risk. This individualised construction of risk and disease has largely ignored the supposedly widely recognised social and political determinants of health and illness.
The impact of reimbursement criteria on the appropriateness of 'statin' prescribing
European Journal of Cardiovascular Prevention & Rehabilitation, 2003
Background In Belgium, regulations restrict the reimbursement of statins to patients with total serum cholesterol above 250 mg/dl (6.41 mmol/l) after a three-month lipid-lowering diet We investigated the possible impact of these regulations on characteristics of Belgian patients receiving a lipid-lowering drug.
Primary Care Physician Perspectives on Barriers to Statin Treatment
Cardiovascular drugs and therapy, 2017
Discontinuation of statin therapy represents a major challenge for effective cardiovascular disease prevention. It is unclear how often primary care physicians (PCPs) re-initiate statins and what barriers they encounter. We aimed to identify PCP perspectives on factors influencing statin re-initiation. We conducted six nominal group discussions with 23 PCPs from the Deep South Continuing Medical Education network. PCPs answered questions about statin side effects, reasons their patients reported for discontinuing statins, how they respond when discontinuation is reported, and barriers they encounter in getting their patients to re-initiate statin therapy. Each group generated a list of responses in round-robin fashion. Then, each PCP independently ranked their top three responses to each question. For each PCP, the most important reason was given a weight of 3 votes, and the second and third most important reasons were given weights of 2 and 1, respectively. We categorized the indiv...
Statins and the Drugging of Everybody
This article argues that “preventive medicine” is an oxymoron, driven by profits rather than health. Using statins as a key example, it critiques the practice of medicating healthy people, warning of the risks to essential body functions. Instead of drugs, it suggests lifestyle and toxin reduction as the true path to lasting health.
The American Journal of Cardiology, 2008
Access to over-the-counter (OTC) statins has the potential to improve public health by reducing cardiovascular events. The Self Evaluation of Lovastatin to Enhance Cholesterol Treatment (SELECT) Study was designed to assess consumers' ability to self-select for treatment with lovastatin in an unsupervised setting. Subjects examined proposed OTC lovastatin cartons with labels that detailed an algorithm for self-selection based on age, lipid profile, and cardiovascular risk factors. Subjects viewed a carton with either a low-density lipoprotein cholesterol-based self-selection algorithm or one based on total cholesterol. Labels also contained warnings against use based on health conditions that might increase the risk of adverse events. Subjects were asked if the drug was appropriate for their use (self-assessment) and whether they would like to purchase the drug (purchase decision). A total of 1,326 consumers provided self-assessment decisions. After viewing the low-density lipoprotein cholesterol-based label, 82%, 36%, and 82% of those who selfassessed that the drug was appropriate for their use were correct with respect to the age, lipid, and risk-factor criteria, respectively. Corresponding numbers for the total cholesterol algorithm were 85%, 50% and 75%. Almost 90% of women aged <55 years who evaluated the drug indicated the drug was not right for them, and women in this age group made up only 9% of the total group of subjects who believed the drug was appropriate for their use. The label was also effective in discouraging use by women who were or may become pregnant, consumers with liver disease, and those with potential drug interactions. In conclusion, SELECT showed that consumers could use an OTC drug label in an unsupervised setting to appropriately self-select for self-management of their cholesterol with lovastatin.
Chewing the fat over statins: Consumer concerns about lipid-lowering medication
PubMed, 2017
Background: The objective of this article was to explore the information needs of consumers using statins. Methods: Calls made to a national medicines call centre in Australia were analysed. Where question narratives were available electronically (n = 1486), the main concerns were identified using a coding scheme. Subsequently, we evaluated whether these concerns were addressed in the medication leaflet. Results: The most common concerns were about side effects (36%) and interactions (28%). Concerns about side effects related to musculoskeletal (27%), gastrointestinal (12%) and skin problems (5%). Concerns about interactions included other medicines (49%), complementary and alternative medicines (CAMs; 39%) and grapefruit (6%). Additional questions related to differences between treatments (12%) and dosage (8%). Most topics were mentioned in the medication leaflet, but strategies to manage these concerns were lacking. Discussion: When prescribing statins, information about common side effects, when symptoms require action, and interactions with other medicines, especially CAMs, should be addressed and tailored to the patient.
Statins-The Most Controversial Drug of Our Times: A Commentary
Era's journal of medical research
Cardiovascular disease (CVD) is the leading cause of death worldwide.Atheroscelerotic cardiovascular disease(ASCVD) is also a leading cause of death and disability. Statins can reduce the risk and prevent heart diseases. One of the best studied medication and in randomized controlled trials have been proven to reduce the no of Heart attacks and stroke even in individuals with normal cholesterol levels. A small no of individuals may develop Diabetes on statins.The benefit from lowering the risk of death, heart attack and stroke are likely to outweigh the development of diabetes in those individuals. The beneficial effects of statins may not only be due to the cholesterol lowering effects but also due to cholesterol independent or pleiotropic effects. These benefits include endothelial protective functions, enhancing stability of atherosclerotic plaques and inhibiting vascular smooth muscle proliferation and platelet aggregation. It remains to be seen to what extent these pleiotropic benefits of statin therapy can be attributed beyond cholesterol lowering.