Statin-fortified Drinking Water in the UK?

Doctors agree that statins reduce the risk of cardiovascular disease — the biggest cause of death in the UK. Studies show they can cut the risk of a heart attack and stroke by a third.
Statins are prescribed for patients known to be at high risk of heart disease, such as those with inherited high cholesterol or who have already had a heart attack. This is known as secondary prevention.
But some doctors are asking "Why stop there?" and are suggesting statins be given to people with risk factors but no obvious disease. This is called primary prevention, to prevent disease from occurring in the first place.
Some have even suggested adding statins to the water supply — a suggestion that sparked a debate recently at the annual meeting of Heart UK, a patient and science charity for cholesterol.
Dr. John Reckless (yes, that's his real name), chairman of Heart UK and a consultant endocrinologist at Bath University, put forward the case for medicated water.
"The whole point of the debate is to bring out the fact that we are under-treating and the fact that a lot more people could benefit," Dr. Reckless explained. "The whole population should be following diet, lifestyle and weight loss measures … Of course we all need that. But on the other hand, rather more people do need statins than are currently getting them.
"So maybe people should be able to have their statin, perhaps if not in their drinking water, with their drinking water … The issue is how far we should be encouraging wider use," he said.
"It is clearly effective and safe to treat with a statin at really quite low levels of risk. That doesn't mean to say we are going to treat everyone but you could do it," he said.
However, Professor Tom Sanders, a nutritionist at King's College, London and nutrition director for Heart UK, disagreed.
He believes that although statins are good for people at very high risk of cardiovascular disease, serious side effects make statins unsuitable for routine use by those at lower risk.
"It's about balancing the side effects. A public health intervention must have no significant side effects and statins do have significant side effects," he said. "One is myositis, in particular rhabdomyolysis — a muscle-wasting disease. It's a very nasty side effect. It can kill you. It occurs in about 0.5 to one in 1,000 people treated and that's with screening. Without screening the incidence might be higher."
Sanders said another problem was the harm it could cause to unborn children. "It causes limb defects and for that reason you could not put it in the water supply," he said.
But Dr. Reckless countered: "You might well have statin-free baby water so that babies and others not at risk don't take their statin."
Dr. Reckless pointed out that similar debates took place when people suggested aspirin use should be widespread. He believes "statins are actually substantially safer than aspirin."
"If you put the average older patient on aspirin in one year, one person in 262 would have a significant gastrointestinal bleed in that one year. The risk with a statin of getting acute myositis to be sufficiently concerned is one per 100,000. So statins are very much safer."
For deaths, he stated: "With aspirin it's one in 2-3,000. The number for statins is about one in a million."
But Sanders said giving drugs was not the answer. He said it was important to focus on diet and lifestyle.
"Putting drugs in the drinking water is medicalization of human activity. It's wrong. You convert people into patients," Sanders said.


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