'More women should be prescribed statins'

Professor Scott Grundy argues in the British Medical Journal that women thought to be at "moderately high" risk of heart problems should be using statins.

His article will reignite the controversy over the effectiveness of the cholesterol-lowering drugs in women.

The drugs are designed to reduce levels of bad cholesterol linked to heart disease called LDLs.

While many studies have found that statins can prevent heart disease in men, the case for women is much less conclusive.

At present, 3.4 million people take statins and NHS spending on the drugs is close to £1 billion a year.

When the entire cost of treatment is taken into account - such as seeing the GP and having blood tests - the NHS may be spending as much as £2 billion a year on statins.

The British Heart Foundation estimates almost 10,000 deaths a year are avoided as a result.

However, lack of evidence for their effectiveness on women - in part because women make up only 16 per cent of those who take part in statins trials - has led some experts to argue against their use.

Professor Grundy, from the Centre for Human Nutrition at the University of Texas Southwestern Medical Centre in Dallas, conceded that not enough women had been included in trials to provide a definitive answer.

Yet he said there was already general agreement that both men and women at high risk of heart disease should get intensive drug therapy.

He argued that those criteria should be expanded so that women at moderately high risk should not be "ruled out" as candidates for treatment simply because of their gender.

Professor Grundy wrote: "Until a large-scale clinical trial is carried out to test the efficacy of cholesterollowering in women at moderately high risk, drug therapy should be avoided in most lower risk women.

"But in those with multiple cardiovascular risk factors and who are projected to be a moderately high risk, use of drugs should not be ruled out."

At present, GPs are given guidance recommending they prescribe statins to anyone deemed to have a 20 per cent or higher risk of having a heart attack or stroke within ten years.

However, GP Dr Malcolm Kendrick, author of The Great Cholesterol Con, said he believed that statins failed to provide any overall health benefit in women and were thus a massive and unnecessary drain on health services.

Statins represent the single greatest drug expenditure in the NHS, he told the BMJ, but none of the large trials of secondary prevention of heart disease has been shown to cut deaths among women.

Dr Kendrick said: "This raises the important question of whether women should be prescribed statins at all.

"I believe that answer is clearly no. In addition to the expense and lack of benefit, statins carry a substantial burden of side-effects."

Dr Kendrick furthermore claimed that being put on a lifelong course of drug treatment may have the effect of making some women falsely believe they did not need to look after their heart by losing weight, exercising and eating healthily.

He added: "We can be fairly sure that stopping prescribing statins to women would save the NHS hundreds of millions of pounds each year.

"Spending millions on a treatment that has no proven benefit and may cause serious harm goes against the rationale of evidence-based prescribing."