High-Dose Statins Could Be Offered Without Prescription

Peter Russell

September 05, 2019

High-dose statins could be made available over-the-counter at pharmacies in an effort to reduce rates of heart disease and stroke, the chief executive of the NHS said.

Low-dose statins can currently be given without a prescription but they are not generally made available by pharmaceutical manufacturers.

It is anticipated that making the most effective and powerful statins available over-the-counter could prevent thousands of deaths, and reduce incidence of heart attacks and strokes.

The NHS said it estimated that as many as two-thirds of people most at risk of heart attack and stroke do not take statins, but would benefit from doing so.

Policy Review Would Be Sent to the MHRA

Chief Pharmaceutical Officer Dr Keith Ridge, and Dr Nikki Kanani, newly-appointed NHS director of primary care, will head a review into how high-dose statins could be provided by high street pharmacists.

The review findings would be presented to manufacturers and the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA would have the final say about how policy would be implemented, NHS England said.

The review comes as the NHS introduces high street heart checks as part of the new £13 billion 5-year contract for community pharmacists. These are due to be delivered by pharmacies in 23 Clinical Commissioning Groups from 1st October, and, if successful, could be rolled out to all community pharmacies in England during 2021 to 2022.

Speaking this week at the NHS Health and Care Innovation Expo in Manchester, NHS chief executive Simon Stevens said: "Pharmacists are highly trained health professionals who are greatly valued by patients. Since the NHS will be funding local chemists to undertake health checks, it makes sense to consider whether there are a broader range of medicines that patients could access conveniently and locally on the high street.

"So the NHS will now work with the MHRA and industry to see how we can best make this happen.

"After cancer lung scanning trucks in supermarket car parks and high street heart checks, this is another step towards making care and treatment more accessible, convenient and effective."

Warning on Over-Treatment

Dr Ridge said: "Hundreds of thousands of people could benefit if industry committed more research and investment in bringing high-dose statins to the high street, and the NHS is going to be driving forward these efforts, as we save thousands of lives from deadly heart attacks and strokes as part of our Long Term Plan.”

He added: "If only 45% of people with a high risk of cardiovascular disease were identified and treated, 6000 strokes and heart attacks could be avoided over the next 10 years."

The Royal College of GPs (RCGP) welcomed the decision to hold a review before implementing the initiative. Prof Helen Stokes-Lampard, chair of the RCGP, commented: "Extensive medical evidence has shown that statins are usually a safe and effective preventative measure against heart disease, and thousands of patients already benefit from statin therapy.

"But GPs are also mindful of the risks of overdiagnosis and over-treatment – a concern we expressed in response to recent NICE guidelines that lowered the threshold for eligibility of statins – and we also have concerns about making these drugs more easily accessible, without a prescription."

NHS England highlighted new research led by the University of Cambridge, and presented at the European Society of Cardiology Conference in Paris this week, that suggested the benefits for cardiovascular health from modest and sustained decreases in blood pressure and cholesterol levels could be higher than previously shown.

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