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Heart disease medication is being massively over-prescribed with thousands of people being wrongly told that they are in danger of developing cardiovascular problems, according to a study.
A new and sophisticated approach to calculating risk has shed radical new light on the issue. A British Medical Journal study says that there are flaws in the traditional method and suggests that current estimates of the number of people in danger of the disease are 1.5 million too high.
Using the new test, the BMJ estimated that the number of people at risk had been overpredicted by 35 per cent.Consequently, many patients have likely been prescribed unnecessarily anti-cholesterol drug statins, inflating the annual £2 billion bill to the NHS.
The study prompted fears that the wrong type of people were being targeted for treatment with its discovery that white middle-aged men had a lower risk than previously thought and women from poorer backgrounds had a significantly higher risk.
It also found that one in three women in their 60s are at risk of heart disease. That figure was previously thought to be one in four.
Julia Hippisley-Cox, lead author of the study, told The Guardian: “We are potentially missing the right people for treatment. “If we use this new score it would increase treatment to deprived areas and especially to women. They are being under-treated across the board.”
The researchers tracked 1.28 million healthy men and women aged between 35 and 74 over 12 years to April this year and used GP records from 318 general practices. The overblown estimates of heart disease were derived from the traditional way of calculating risk, which involves a score based on smoking, blood pressure and “good” and “bad” cholesterol, along with age and sex.
The BMJ study used a new measure which also takes social deprivation, genetic factors and weight into account, reducing estimates.
As a result, it has concluded that 3.2 million adults under the age of 75 are at risk of developing cardiovascular illnesses compared with the 4.7 million previously estimated. A separate study by the Healthcare Commission says the number of people reported as having heart failure issues was 140,000 fewer than expected.
In another development, specialists warned that patients at high risk of a heart attack are often unsure when to dial 999.
They are so used to pain from angina that they cannot easily distinguish it from the pain of a heart attack, and may wait too long before calling an ambulance.
In an editorial in the BMJ, the authors said: “Ideally, patients would be able to distinguish stable angina from a potentially life-threatening acute coronary syndrome, but in reality they do not.”
The British Heart Foundation advises patients with angina that chest pain lasting more than 15 minutes is probably a heart attack. They are advised to use their glyceryl trinitrate (GTN) sprays three times at five minute intervals before calling an ambulance.
But for some high-risk patients, waiting 15 minutes could be too long, the authors of the editorial argue.
One study has shown that the average time from onset of symptoms to heart attack is 10 minutes, and manufacturers of sprays can offer different instructions — for example, recommending no more than three doses and leaving 15 minutes between treatments. The authors advise patients at high risk of an attack or with known ischaemic heart disease to carry a GTN spray at all times.
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I suffered chest discomforts whilst carrying out an occasional exercise and had difficulties with breath control after walking up the stairs. I was admitted to hospital for an angiogram which indicated clear arteries around the heart. Nevertheless, I was prescribed an anti-angina drug (dipyridamole aka Persantin, Cerebrovase or Modaplate) and aspirin. Within 30 minutes of taking the Persantin my chest muscles started to tighten and, despite taking a dosage of glyceryltrinitrate spray, the tightening continued. I phoned for medical help and was advised to contact the emergency services as I was undergoing a heart attack. I was discharged the following day and prescribed Simvastatin. It seems that I reacted anomalously (1 in 10,000) to the Persantin. The cardiologist still insists that I am suffering from angina despite the absence of evidence for artery blockage around the heart and am left with the lingering feeling that my original condition was unfitness.
Maxadolf, Bodnegg, UK
When there is opinion difference, or estimates are revised, caution may sometimes be indicated.
dr venables preller, Warminster, UK
As a 56 year old short, plump woman, I told my GP about chest pains I was experiencing and feeling unwell. I was put on statins, which made my feet stiffen up, and a very large dose of betablockers which nearly killed me. I explained to my GP that I didn't think I really had a heart problem and that the drugs I was being prescribed were making me very ill. He said as a newly diagnosed patient I must be in denial and showed me the door. I then paid for heart tests to be carried out by a specialist and these proved negative. The cardiologist said I must therefore have Syndrome X which means I am 'likely' to get heart disease. Luckily for me whilst overseas I saw a doctor who thought I had a gallstone problem and I now have a collection of 27 ranging from marble to various seed sizes which the kind surgeon gave me when I came round from having my gall bladder removed. How can anyone trust the UK doctors when they are so obsessed with diagnosing heart disease?
liz, Barnstaple, UK
Sympathy must be felt for those people that were uneccessarily worried about having or likely to develop CHD at some stage in the future. It is applaudable that scientists are still heavily conducting research in this area of medicine, and that such an issue has been detected. However, I do not agree with the BMJ studyâs argument that the original measure used was, in fact, âflawedâ. The fact that particular factors had been initially overlooked in the system of CHD assessment does not mean that mistakes were necessarily made, as âflawâ implies. It is a welcome development that the method of assessment has been now revised taking such factors into account. There is a further important issue at stake; will those people who had to buy medicines, to tackle the purported heart condition which did not materialise, be compensated for the expenditure incurred? The answer can be provided on the same breath; of course not. Instructions on the administering of drugs should also be standardised.
Marcin Roth, London , UK
Since when have Doctors ever got anything right? I know far more people incorrectly diagnosed than correctly, or not diagnosed at all. I'd have to be near death before I'd trust one. Have you ever met these people socially? I'd advise that you all get to know at least one you'll soon change your mind about them. They are mostly self-obsessed.
judy, Liverpool, england
I am a 62 years old male and for the last two yeras our health system has me in its grip. Having been prescribed one set of drugs that was increased to two. No problem as it started to lower a raised bllod pressure. I was then tol I required a cholestrol teast wich gave reading of 17% chance of CVD in the next ten years. Statins were prescribed. Howevr the side effects seem huge. I am now told by NICE that the rigger for Statins is 20%. There are also natural solution to raised cholestrol porridge - fish oil tablets etc. None of this was mentioned. The whole business seems far from perefect.
Mike J Bamford, West Yorks,
I am a 62 years old male and for the last two yeras our health system has me in its grip. Having been prescribed one set of drugs that was increased to two. No problem as it started to lower a raised bllod pressure. I was then tol I required a cholestrol teast wich gave reading of 17% chance of CVD in the next ten years. Statins were prescribed. Howevr the side effects seem huge. I am now told by NICE that the rigger for Statins is 20%. There are also natural solution to raised cholestrol porridge - fish oil tablets etc. None of this was mentioned. The whole business seems far from perefect.
Mike J Bamford, West Yorks,
Yours and the Guardians headlines are unnecessarily sensationalist. I have recently been prescribed statins by my GP but although heart disease was mentioned, the main message was that statins would simply reduce the risk that anything serious might happen. What is more surprising is the almost complete absence in media coverage of the somewhat controversial view of the beneficial effects of statins. I am still trying to get hold of a copy of 'Cholestrol Myths: Exposing the Fallacy That Saturated Fat and Cholesterol' but it is rarely mentioned in healh coverage.
William Hudson, Abingdon, UK
Since when has drug prescription been about curing people? I remember seeing on GMTV years ago a Professor who had just retired from the drugs industry and he said they weren't interested in producing cures for anything just drugs that held the problem in abeyance as then they could go on making money year after year. That is the sad reality, shareholders before people's lives every time. Why do you bother even reporting these stories? We all know what these drug companies do to persuade so-called doctors to prescribe their drugs so they can have three skiing holidays a year. Just who are these NHS "doctors" really working for? Takers of the hypocritical oath.
John, Dundee, UK
So the great 'you're at risk of / have heart disease so you must have a daily statin for the rest of your life' scam has been blown. The drug manafacturering companys will be seriously disturbed that their lie has been exposed. For so long they and their generously maintained eminent Medical men who perpetuate the lie have benefited from keeping huge numbers of the trusting UK public dosed up to the eyeballs on these dangerous drugs. Dull witted and naive General Practitioners are their pushers. I'm a GP so I have some experience of what is going on.
Dr R G Allen, Canterbury, UK