Irish cardiologists are warning against following Britain's plan for preventing heart disease. Theresa Judgereports.
A leading cardiologist has cautioned against the Republic following Britain's lead in considering the introduction of general screening for heart disease.
A British plan envisages screening all adults aged 40, 50 and 60 and offering cholesterol-reducing drugs - statins - to those considered to have a 20 per cent risk of developing heart disease over the following decade.
Prof Ian Graham, a consultant cardiologist at Tallaght hospital who is also chairman of the joint European taskforce on the prevention of cardiovascular disease, says the danger of such an approach is that it puts too much focus on one risk factor - cholesterol levels - and takes the emphasis off general lifestyle habits such as smoking, the need to take exercise and eat a healthy diet.
"I believe it's a little paternalistic to say the State will screen everybody," says Graham, who would prefer an approach that encourages personal responsibility and educates people to assess their own risk levels and reduce their chances of developing heart disease.
"I firmly believe that educational programmes should start in childhood, in primary schools because even young children can understand the concept of risk," he says.
While the British authorities should not be criticised for introducing screening and offering statins, he says the message that such a policy sends out could be described as "chemical salvage".
People need to know there are a lot of options for them to reduce their risk of cardiovascular disease.
"There is no doubt that if everybody took statins it would reduce deaths but I think it is a very sad solution to what is basically a lifestyle problem," he says.
Some 11,000 people die in the Republic each year from conditions related to heart disease, stroke and the circulation system. About 6,500 of these die from heart attacks, the equivalent of 18 people a day, and Graham says these are "substantially preventable" and "mostly lifestyle-related".
However, since the mid-1970s there has been a significant reduction in deaths from cardiovascular disease.
Graham argues that the focus needs to be on total risk, taking into account all the main risk factors, which are age, being a male, smoking, high blood pressure and cholesterol. Doctors use a formula based on all these to calculate a person's risk level.
While cholesterol is one of the risk factors, it should not be over-emphasised, Graham says.
He points out that a 60-year-old woman with a cholesterol level of eight but with no other risk factors has only a 2 per cent chance of dying from heart disease within 10 years, while a man with cholesterol of five, who smokes and has high blood pressure has a 20 per cent chance of dying within 10 years - 10 times that of the woman with higher cholesterol.
Graham stresses the importance of not smoking, taking daily exercise - a 30-minute walk at least - eating five portions of fruit and vegetables a day, and reducing high fat foods. While there is a genetic element to your chances of getting heart disease, following these guidelines can "adjust your chances very substantially".
While Graham is sceptical of the message that statins can be given to everybody with a problem, he and other cardiologists stress that their effectiveness in reducing deaths is "overwhelming".
The use of these drugs has also been increasing over recent years here - in 2005 some 2.7 million prescriptions for statins were written for patients in the Republic.
The amount spent on the drugs under the medical card, long-term illness and drug reimbursement schemes was €105.5 million.
Until now in Britain there was a government target of offering statins to people with more than a 30 per cent chance of developing coronary heart disease within 10 years. However, the new recommendations from Britain's National Institute for Health and Clinical Excellence advocates screening and offering statins to anybody judged to have a 20 per cent chance of developing the disease.
One reason being given for the change is that there are variations in how doctors treat people at risk of heart disease.
The Irish Heart Foundation says that while it would be broadly in favour of the British recommendations, there needs to be careful examination of them by the Department of Health and the Irish Medicines Board.
President of the foundation, Prof Eoin O'Brien, says that while there are minor side effects associated with the use of statins, it is very rare that a person would have to stop taking them, and their effectiveness is beyond question.
He points out that the first statin has recently come off patent so the cost of these drugs should start to reduce over coming years.
While statins are not cheap, O'Brien points to the huge social and economic costs associated with strokes and heart attack. Some 70 per cent of people who have a stroke never recover fully.
Current priorities for the heart foundation are to encourage people to stop smoking, for the effective control of blood pressure and cholesterol.
Blood pressure is the main determinant of a person's risk of stroke, he says, and yet only half those with high blood pressure are diagnosed, only half of these get treated, and only half of those who do receive treatment are treated effectively, in that their blood pressure returns to normal levels.
Dr Declan Sugrue, consultant cardiologist at the Mater Hospital, says there is a valid economic argument for introducing screening and prescribing statins to cut rates of stroke and heart attacks.
"The general trend in medicine over the past 30-40 years is for early detection and screening rather than treating advanced disease," he says.
However, on the question of widespread prescription of statins, Sugrue says that while they can reduce risk they do not eliminate it.
It is important, he says, not to give a message that people can "eat, drink and be merry" and then take a tablet that can solve all their problems.
Do you believe statins should be prescribed in Ireland to help prevent heart disease?
E-mail healthsupplement@irish-times.ie with your views. A selection of your replies will be published.
What are statins?
Statins are drugs that reduce the amount of cholesterol in the blood by inhibiting an enzyme essential to its manufacture.
Cholesterol is a type of lipid - fats found in the body - which, if present in too high a concentration, can cause deposits to build upon artery walls, increasing the risk of heart disease.
Atherosclerosis occurs when fatty deposits build up in the arteries and disrupt the flow of blood.
A study in the medical journal The Lancet in June found that statins "seem to be a remarkably safe group of drugs when used at their usual doses".
They are prescribed for people with cardiovascular disease and those considered at risk of developing it.