The breakthrough FIVE MINUTE test that reveals if you really need statins

EVERY day, around eight million Britons dutifully swallow statin tablets prescribed by their GPs to reduce their risk of heart disease. The drugs are designed to lower cholesterol, t hus slashing t he chances of a fatal heart attack, and they are among the most widely used medicines in the world.

Yet mounting evidence suggests a significant number of people need not be taking them in the first place. More worrying, others with ‘hidden’ cardiovascular disease – who would benefit from drug treatment – are thought to be missing out because they tick too few of the ‘high-risk’ boxes GPs use to work out the danger to patients’ health.

Given that statins can have side effects ranging from headache and nausea to muscle cramps, many patients would jump at the chance to find out if they really need to be taking them. Research suggests just 50 per cent of adults prescribed the drug stay on them for more than a year.

So imagine if there was a rapid, non-invasive and highly accurate test to show – once and for all – who really needs to be on the pills? Well, such a test already exists in the UK.

But while it is readily available at private clinics, it is not widely used on the NHS.

Now, as clinics across the United States roll out the five-minute test for all patients with an intermediate risk of a heart attack, British experts are questioning whether to deploy this powerful weapon on the front line of the war against killer heart disease.

Called calcium scoring, the procedure involves a non-invasive CT scan, which uses X-rays of the heart to look for calcium deposits in the coronary arteries. The deposits can cause them to narrow, and increase the risk of a heart attack. This calcium, unrelated to calcium consumed in our diet, occurs as cholesterol and fat builds up in the arterial walls over time, prompting inflammation. The body’s response to inflammation is to deposit calcium, which stiffens the arteries.

There is also growing excitement about a more sophisticated form of the test, called CT coronary angiography ( CTCA), which could prove even more revolutionary, say experts. This scan not only maps calcium and the degree of narrowing in the arteries, but detects fatty cholesterol deposits that can build up inside heart arteries without symptoms, particularly in the young, who may have no calcium in the arterial walls.

Some cardiologists now believe these highly effective tests should be used to screen patients before they get ill to see if they already have harmful calcium deposits lining their arteries. This more targeted tactic could mean statins are directed specifically at those who need them, rather than what some critics say is more of a ‘carpet bombing’ approach.

Dr Paul Jenkins, medical direc- tor of the private European Scanning Centre, which offers both calcium scoring and CTCA, said: ‘CTCA is the only technique which can detect what cardiologists call the “widow makers” – the areas inside the coronary arteries comprising cholesterol and l i pids which haven’t yet calcified but which can suddenly burst, causing a total blockage, and kill by causing a massive heart attack without any prior warning.’ The tests are only currently available on the NHS to patients with chest pain who are being investigated for heart disease. Extending their availability to everyone who qualifies for a free heart risk assessment would be hugely expensive. CTCA also requires scanners which can cost up to £2 million each.

Critics also caution that the test involves being exposed to small amounts of radiation. But supporters say it could prove cost-effective in the long run if significant heart disease could be prevented.

Currently, GPs assess a patient’s heart risk during a NHS Health Check by using a scoring system called Qrisk.

It gives a general idea of cardiovascular risk over the next decade based on factors including cholesterol, blood pressure, age, weight and health history. Anyone with a risk of ten per cent or more will be offered statins, according to guidelines.

But Qrisk does not measure the actual condition of a patient’s arteries. As a result, some experts fear that millions may be taking cholesterol-lowering medication when they do not need to.

Data compiled by the European Scanning Centre, based on more than 3,000 cases, suggests that almost 60 per cent of women, and 40 per cent of men under 55 being treated with statins under the current guidelines, have perfectly healthy heart arteries, meaning they probably do not need medication. The astonishing study also found that around a quarter of men and 15 per cent of women may have such significant calcium deposits that the standard dose of statins dished out by GPs would be inadequate to treat it. These patients, say experts, would require further medication or a surgical procedure to lower their heart attack risk.

The study also looked at men and women who were not on statins, and were otherwise healthy with no symptoms of heart disease.

In this group, more than half of men over 55, and almost a third of those aged 40 to 55, had calcium build-ups that put them at risk of heart disease.

Shockingly, around 17 per cent of the older men were in the highest risk category, meaning a sud-

One in three Britons have high blood pressure, and half are not receiving any treatment. Experts fear millions may be taking the drugs when they really don’t need to

den heart attack would be likely.

Dr Azad Ghuran, consultant cardiologist in London and Hertfordshire, said: ‘One patient I saw was 35, with low cholesterol and a normal BMI and blood pressure but was having chest and hand pain. His QRISK score was just two per cent. You’d probably say he didn’t yet need a statin. But investigations showed all three of his arteries were severely narrowed.’

In such serious cases, patients can have bypass s urgery to improve blood flow around the heart and reduce the risk of a heart attack. Alternatively, they can opt instead – as Dr Ghuran’s patient did – to have less invasive surgery to insert stents to widen the arteries.

Trials are investigating the benefits of CTCA. Later this year, a British Heart Foundation-funded study called SCOT-HEART2 will start to recruit up to 10,000 people aged 50 to 70 with a single risk factor for cardiovascular disease, such as smoking, high blood pressure or raised cholesterol.

The trial will examine whether CTCA improves long-term health outcomes as well as the cost-effectiveness of picking up heart disease earlier.

Professor David Newby, BHF’s Duke of Edinburgh Chair of Cardiology at the University of Edinburgh, who will be leading the study, said: ‘We hope to identify people who are asymptomatic who are actually at risk of heart attacks – and prevent those heart attacks. It could justify giving the scan to people with a singular risk factor.

‘But we need the evidence before recommending it as a standard screening test.’ NHS patients being investigated for heart disease s o meti mes o n l y receive a calcium score, using a standard CT scan, which reveals whether they have calcium deposits present and may need further treatment. In contrast, CTCA provides a map of the heart and the precise location of any blockages, but can only currently be done in a handful of NHS trusts which have the expensive scanners.

In the US, where Donald Trump had a CTCA scan in 2017, medical guidance to doctors recommends wider use of the calcium scan.

The American Heart Association says all patients over 55 – even if they have no symptoms of heart disease – as well as younger patients over 4 0 wh o have an intermediate risk of having a heart attack, should be tested. It follows studies showing half of those aged 45 to 84 offered statins actually had a calcium score of zero, which means the drugs were not clinically necessary. It will not be a cheap solution. Mr Jenkins says: ‘The scanners also need experienced radiographers to operate them as they’re like Formula 1 cars.’ Others question if the evidence currently supports CTCA’s use for routine screening. One study, SCOT-HEART1, found that it cut the number of deaths from heart attacks by nearly half within five years. But Jonathan Hill, consultant cardiologist at HCA London Bridge Hospital, warned: ‘CTCA will replace calcium scoring for investigating chest pain, but the screening question is controversial in otherwise healthy patients. The radiation risk, although it’s going down, i s not quite l ow enough with most machines.’

Professor Sir Nilesh Samani, medical director of the British Heart Foundation, said that while CTCA was an ‘important tool’, its use over and above calcium scoring alone was ‘somewhat debatable’. He said: ‘We need to find out which groups could benefit, which is what SCOT-HEART2 will do.’

However, Dr Jenkins added: ‘If this could be introduced for every patient over 40, you’d save on statin prescriptions and long term on potential heart problems too.’

Annual heart deaths have roughly halved in the past 50 years, from 320,000 in 1961 to 150,000 last year.