12. Sensible prescribing in older people with Jonathan and Lucy; Statins

In this episode of Talking Meds we continue the series ‘Sensible prescribing in Older people with Jonathan and Lucy' with a discussion between Jonathan Underhill and Dr Lucy Pollock about the prescribing of statins.

So we meet Mrs Evans, an 87 year old lady who lives with her daughter in a ‘granny flat’ annex of her house. She has several co-morbidites including type 2 diabetes, hypertension, heart failure with preserved ejection fraction and has recently had a stroke. Her daughter is concerned about her mum who she says ‘the sparkle has gone from her eyes’. Mrs Evans often looks at her daily handful of medicines and asks ‘what’s the point?

Mrs Evans has recently been prescribed atorvastatin 80mg a day - in line with the guideline from NICE. Mrs Evan’s daughter asks Lucy - ‘are these new tablets worth my mum’s time?’ To try and help answer this, Jonathan and Lucy look at the icon arrays on the statins tab of GP Evidence where it shows how, out of 100 people like Mrs Evans who don't take a statin, around 29 will have a heart attack or stroke in the next 10 years. If all 100 take a statin, then 7 will be prevented from having a cardiovascular event but 22 will still have one. So the majority, 78, will not have a heart attack or stroke, but 71 wouldn’t have had one anyway without taking a statin!

Explaining risks and benefits using numbers can often help some people - but not everyone. The important thing is to ask and find out 'what is it that really matters to you?'

PrescQIPP resources mentioned in this episode:

PrescQIPP Lipid modification e-learning course (pay per use)

PrescQIPP Prescribing Mastery webinar 'Cholesterol management' 

Other resources mentioned in this episode:

BBC Podcast with Rory Stewart - the long history of ignorance

Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238)

Risk communication: NICE Shared Decision making guideline recommendations 1.4

Drug and Therapeutics Bulletin - How to communicate evidence to patients by Baroness Alex Freeman

A new episode of Talking Meds will be available every other Friday.
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