The British approach to cholesterol: A reason for lower health costs

The American Heart Association and American College of Cardiology recently published new guidelines for screening and treating cholesterol.

In some ways these guidelines are more like the British guidelines. Instead of setting up doctors and patients to fail by calling for certain cholesterol number targets as in the old U.S. guidelines (i.e. LDL level below 100), they instead focus on putting higher risk patients on drugs called statins and then not worrying about the new cholesterol number under treatment. It’s more simply: high risk, take statin; low risk, don’t take statin.

Of course these guidelines don’t come without controversy. Some estimate the number of adults recommended to take statins will double. Others criticize the spreadsheet that comes with the guidelines as exaggerating the true risk of developing heart disease by 75% to 150%.

The other factor that has gotten less press is the definition of high risk, even if the heart disease calculator is accurate. The AHA/ACC definition of high risk is a greater than 7.5% of developing symptomatic heart disease (not death) in 10 years. The British define high risk as a 20% chance in 10 years.

This is clearly a huge difference and it speaks to the underlying cultures of the two countries. The U.S. doctors and the large foundation that supports them err on the side of assuming more is better, and any theoretical benefit — no matter how high the cost — is worth it.

The British err on the side of being sure that the benefits of drug therapy is clearly greater than the risks of adverse events, and they take costs into consideration. Some people are simply at too low a risk to justify the expense and hassle of a lifetime of drugs.

I wrote earlier about explaining why screening and treating people for high cholesterol does not save money, even in the long run.

The British people and their government are willing to tell its healthcare industry that it can’t have everything it wants, and that other societal goods improve health as well. This is one of the many reasons the British people enjoy better health at less than half the cost of the U.S.

Richard Young is a physician who blogs at American Health Scare.

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  • Suzi Q 38

    Thank you so much.
    I have had statins pushed on me for several years.
    Granted, I have a scary family history of heart disease.

    The problem is that not only are these drugs horrible, they are expensive.
    I sure hope that they were worth it.

    I have severe muscle weakness, borderline diabetes, forgetfulness, and need to have my liver checked regularly with blood tests.

    The muscle weakness did not help my myriad of nerve symptoms from my spinal stenosis.

    I finally tried taking a “vacation” (about 4 months) from my statin, and am feeling markedly better. I just took a blood test and told my doctor that if my numbers were “scary,” we could talk about other drugs.

    I lost 40 pounds, and my numbers did not budge. My BMI is about 24 or 25.

    I think the drug companies have scared the doctors with respect to the statins.

    For BP, I was on Diovan.
    My insurance company was dutifully paying for it. It was working.
    The cost was about $200.00 or so for #30 (one month) and I was “floored.” I had to pay out of pocket, as my deductible was not met.

    I asked the pharm D for an alternate suggestion to treat my BP, and she suggested Cozar, a generic. I relayed this to my doctor, and he called in a prescription of the Cozar. This generic drug, at $10.00 for my co-pay, is working beautifully, even better than the Diovan did.
    Here there are other, less costly drugs available, and I have been on a $200.00 a month medication for my BP.

    I don’t care if my insurance is paying for it. I need to do my part to keep costs down if other drugs work just as well for me.

    My point is that I hope that I can do without my statin for now.
    These blood tests will tell the story.
    I am interested if my borderline diabetes score is there due to family history, eating, or the statin.

    If I have to get back on it, I will. This time, though, I will be asking some questions.

    Thank you.

  • LeoHolmMD

    The selection of 7.5% seems arbitrary. Risk is something seen through the eye of the beholder. For patients, the number needed to treat or absolute risk reduction would be most useful. Mayo has a good calculator that addresses this.

  • whoknows

    Speaking of cholesterol… Happy Thanksgiving to all on this site. It has been quite informative and lively.

    • Suzi Q 38

      Thank you!
      Same to you.
      I will try to eat responsibly.

  • Frank Lehman

    Can someone explain to me why it is that when using the risk calculator on the American Heart Association website, the estimated risk (all other factors being equal) is significantly higher for whites (WH) than for African Americans (AA)?

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