TY - JOUR T1 - Prescribing statins in general practice: who decides? JF - British Journal of General Practice JO - Br J Gen Pract SP - 246 LP - 247 DO - 10.3399/bjgp17X690953 VL - 67 IS - 659 AU - Nick Steel AU - Bob Fleetcroft AU - Yasmeen Hassan Y1 - 2017/06/01 UR - http://bjgp.org/content/67/659/246.abstract N2 - GPs have been debating the pros and cons of statins for different patients since the 4S trial back in 1994 first showed that statins could reduce mortality from strokes and heart attacks in those with existing cardiovascular disease.1 The whole country seemed to be debating them in September 2016, with Rory Collins explaining on BBC Radio 4’s Today programme that the benefits were ‘100 times the harms’. Collins had led a new review of the statins trials which concluded that the evidence strongly supported the benefits of statins and showed very modest risks. The review argued that ‘exaggerated claims about side effects’, often based on observational data, may have contributed to lower than recommended levels of statin use in individuals at increased risk of cardiovascular disease.2 Primary care data show that statin prescriptions are lower than recommended for high-risk groups.3The arguments about the evidence have been well rehearsed, and it is hard to come to any other conclusion than that statin therapy has prevented a great many heart attacks and strokes in those with pre-existing cardiovascular disease. Important gaps remain, however, such as uncertainties over the long-term harms of statin therapy; the greater incidence of side effects such as muscle pain seen in clinical practice than reported in trials; the lack of trial data on the elderly (at least until the results of the STAREE study in the over-70s become available after 2020);4 and, importantly, the difficulty of comparing risk in trial populations with the output of risk calculators such as QRISK2, which is routinely used in UK general practice. It is also premature to dismiss large observational datasets that, despite the problem … ER -