High cholesterol can lead to blocked blood vessels which cause heart attacks and stroke

The study of 175,000 patients, in the Lancet, said even very low-risk patients benefited from the medication.

The Oxford researchers says the NHS should consider giving statins to healthy people. The NHS drugs watchdog, NICE, is reviewing the evidence.

However, statins have been linked to side-effects such as kidney failure.

‘Unparalleled’ detail

They are among the most widely prescribed drugs in the UK and have long been known to help people at high risk of heart attack and stroke.

However, there has been considerable debate over medicating healthy people – both whether it works at all and if it would be socially acceptable.

Researchers at the University of Oxford say they have investigated the issue in “unparalleled” detail.

Their review of 27 trials concluded that statins significantly reduced the risk of heart attack and stroke for everyone.

Current rules from NICE – the National Institute for Health and Clinical Excellence – recommend statins for people who have a 20% or greater chance of developing cardiovascular disease within 10 years.

Doctors look at a patient’s age, blood pressure, cholesterol levels and lifestyle to work out the risk.

One of the researchers, Prof Colin Baigent, told the BBC: “We’ve been taught over the years that high cholesterol is the thing that matters; you mustn’t have high cholesterol.

“But what we’ve actually learned is that, whatever your level of cholesterol, reducing it further is beneficial.

“Whatever your level of risk, the benefits greatly exceed any known hazard.”

He calculates that lowering the threshold for prescribing statins to a 10% risk of cardiovascular disease within a decade would lead to five million more people taking the drugs.

This in turn would save 2,000 lives and prevent 10,000 heart attacks or strokes every year, he said.

Prof Baigent said: “Half of [these] deaths come out of the blue in people who were previously healthy.

“If we are going to prevent that half of cardiac or stroke deaths, then we’ve got to consider treating healthy people.

“It can’t be done any other way.”

Caution urged

He, alongside fellow researchers, is now calling on NICE to review the evidence for giving statins to more people.

NICE, which sets drugs policy for England and Wales, said it was updating its guidelines.

The organisation said: “New evidence on statin treatment thresholds that has become available since publication of the original NICE guideline, including the study reported in the Lancet, will be considered as part of our review.”

Their conclusions will be published towards the end of 2013.

One of the questions will be over side-effects. Statins have been linked to liver problems, kidney failure, muscle weakness and an increased risk of diabetes.

Prof Shah Ebrahim, from the London School of Hygiene and Tropical Medicine, conducted a large review of the evidence last year.

His results urged caution, and Prof Shah said doctors should stop prescribing to healthy patients.

He now says: “This research provides further evidence that statins are an effective and safe way of reducing the risk of heart attacks and strokes even among people at quite low risk of these conditions.”

He suggests that universal prescribing to the over-50s might be appropriate, as 83% of 50-year old men have a 10% risk of cardiovascular disease in the next 10 years.

“The benefits of giving statins to everyone over the age of 50 would probably save the NHS money in the long run, owing to the savings in health care costs from the heart attacks and strokes prevented.”

However, he questioned whether it would be good for people or society to resort to mass medication for lifestyle issues.

By James Gallagher
Health and science reporter, BBC News

Blood tests have traditionally been used to detect the HIV virus

A panel of experts said the OraQuick In-Home HIV Test was safe and effective and its potential to prevent infections outweighed the risk of false results.

The Food and Drug Administration will decide this year whether to approve it.

The 20-minute test is 93% accurate for positive results and 99.8% for negative, the manufacturer said.

HIV affects nearly 1.2m people in the US, with 50,000 new cases each year.

‘Game changer’

Experts on the Blood Products Advisory Committee voted 17-0 to back the test, saying it would help people who are HIV-positive get access to healthcare and social services.

They urged Pennsylvania-based OraSure, the company that manufactures the product, to include highly visible warnings about false negative results.

The panel also advised that the packaging should carry a toll-free phone number offering counselling to those testing positive.

Carl Schmid, deputy director of the AIDS Institute, welcomed the panel’s approval on Tuesday of the home test.

“We are always looking for game changers, and we believe this is one of them,” he told the Associated Press.

“Not only will it help reduce the number of infections but it will bring more people into care and treatment.”

The Food and Drug Administration (FDA) does not have to follow the recommendations of the advisory panel, though it usually does.

In 2004, the FDA approved a 99%-effective version of the test for use by healthcare professionals.

OraSure said the home test could retail for less than $60 (£37) if approved.

To take the test, the user swabs the outer gum area so the oral fluid, which is not the same as saliva, can be checked for the HIV virus.

The test provides results within about 20 minutes, but experts say the results should be confirmed with a blood test, which is more accurate.

Last week, a separate FDA panel approved a drug called Truvada, which could become the first drug in tablet form to protect healthy people from the HIV virus.

BBC News

The implants were manufactured by the French company Poly Implant Prothese (PIP)

The review was led by Health Minister Lord Howe and examined the role of the Department of Health and the UK regulator the MHRA.

It questions how well women with these implants were informed about the risks.

It says that although the MHRA followed scientific and clinical advice, it should “review and further develop its communications capability.”

And it must “obtain evidence from a wider and more detailed set of sources…”

The issue is with safety of silicone breast implants made by the French company Poly Implant Prothese (PIP).

The firm’s products were banned in 2010 when it emerged that industrial grade silicone was being used. Implants should be made from medical grade material, which has passed safety tests for use in a human body.

The report says this was a case of deliberate fraud by the PIP manufacturer and regulation alone cannot prevent that.

But it says a “higher level of proactive public communication could have been helpful”, especially while awaiting toxicology test results. It suggests a more creative interaction with affected women, perhaps through use of social networking (like Facebook) could have been useful.

In March the Commons Health Committee criticised the government and health regulator for failing to adopt a high profile sooner.

‘Serious lessons’

Lord Howe says there is no evidence that the MHRA or the Department of Health significantly failed to do their job.

“But serious lessons must be learned from this scandal. The MHRA needs to look at how it gathers evidence so it is able to identify problems early. It needs to better analyse reports about higher risk medical devices. And it needs to improve the way it communicates with the public.”

You can hear my interview with Lord Howe here:

Between 2003 and 2010 more than 20 letters were sent from the MHRA to PIP raising concerns about the implants. In hindsight, “this body of evidence could be seen as suggestive of a problematic manufacturer.”

The review concludes that regulators in all EU countries need to work better together to support early detection of problems, share the information they gather and take appropriate action to protect patients.

Commenting, the President of the British Association of Aesthetic Plastic Surgeons, Fazel Fatah, said: “Poor post-marketing surveillance of medical devices lies at the root of the PIP crisis. At the BAAPS we feel there needs to be significantly more stringent monitoring of all medical devices including breast implants and all cosmetic injectables, via compulsory, regular reporting of adverse effects and mystery shopping which are all part of our regulation proposals.”

cosmetic surgery
Around 47,000 women in the UK have PIP breast implants. Around 95% were fitted privately. A minority of operations were carried out on the NHS, mostly for breast reconstruction following cancer.

Lord Howe’s review into PIP implants is one of two set up by the Department of Health in January.

The second review, led by Professor Sir Bruce Keogh, the NHS Medical Director, will look at whether the cosmetic surgery industry needs to be more effectively regulated.

In January Prof Keogh’s team concluded there was insufficient evidence to recommend the routine removal of PIP implants. But it recognised the concern that the issue was causing.

It found there was no link between PIP implants and cancer, and the evidence on increased rupture rates was inconclusive.

Throughout the UK any women who had PIP implants fitted on the NHS can get them removed and replaced free of charge.

In Wales the NHS will also replace those of private patients. In England and Scotland the NHS will remove implants of private patients but not replace them.

Latest figures from the Department of Health in England show that 6,632 women with private PIP implants have been referred for hospital checks; 3,865 scans have been completed.

433 women have decided to have the implants removed and 185 have had the surgery.

836 NHS patients with PIP implants have been contacted, 82 scans completed. 214 decisions have been made to remove the implants and 66 women have had this surgery.

BBC News

Half of all child deaths occurred in Africa

A US team, writing in the Lancet, looked at mortality figures from 2010.

They found two-thirds of the 7.6m children who died before their fifth birthday did so due to infectious causes – and pneumonia was found to be the leading cause of death.

One expert said it was very important to “translate such findings into action”.

The team from Johns Hopkins Bloomberg School of Public Health looked at data from a range of sources, including household surveys and registration systems for 193 countries. Mathematical modelling was used where data was incomplete.

They found child deaths had fallen by two million (26%) since 2000, and there have been significant reductions in leading causes of death including diarrhoea and measles – as well as pneumonia.

But they say there are still significant challenges.

International targets

Half of child deaths occurred in Africa – two thirds (2.6m) were due to infectious causes, including malaria and Aids.

In South East Asia, neonatal causes were the leading cause of death.

Five countries (India, Nigeria, Pakistan, Democratic Republic of Congo and China) accounted for almost half (3.75m) of deaths in children under five.

The researchers warn that very few countries will achieve international targets for improving child survival – the Millennium Development Goal (MDG) 4 – by the 2015 deadline.

Only tetanus, measles, and HIV/Aids have fallen enough to meet the target.

Writing in the Lancet, the researchers say: “Across all the previous and current rounds of causes of childhood death estimation, pneumonia and pre-term birth complications consistently rank as the leading causes at the global level.

“Africa and South East Asia are repeatedly the regions with the most deaths in children younger than five years.

“Our trend analysis shows that accelerated reductions are needed in the two major causes and in the two high-burden regions to achieve MDG4 by 2015.”

BBC News

Drawing lines between ascending numbers- the test needs to be done as fast as possible

Taken while healthy, the test involves drawing lines between numbers in ascending order as fast as possible.

Men who scored in the bottom third were about three times as likely to die after a stroke compared with those who were in the highest third.

The study looked at 1,000 men between the ages of 67 and 75 over 14 years.

Of the 155 men who had a stroke, 22 died within a month and more than half within an average of two- and-a-half years.

The researchers think that tests are able to pick up hidden damage to brain blood vessels when there are no other obvious signs or symptoms.

Silent injury

Dr Clare Walton, from the Stroke Association, said: “This is an interesting study because it suggests there may be early changes in the brain that puts someone at a greater risk of having a fatal stroke.

“This is a small study and the causes of poor ability on the drawing task is not known. Although much more research is needed, this task has the potential to screen for those most at risk of a severe or fatal stroke before it occurs so that they can benefit from preventative treatments.”

Dr Bernice Wiberg, lead author from Uppsala University in Sweden, said: “As the tests are very simple, cheap and easily accessible for clinical use, they could be a valuable tool – alongside traditional methods like measuring blood pressure (and) asking about smoking – for identifying risk of stroke, but also as a possible important predictor of post-stroke mortality.”

She also suggested it could help improve information given to patients and their family.

More than 150,000 people suffer a stroke every year.

BBC News