Are cholesterol medicines overused?

1 December 2011

Medicines to treat cholesterol may be being prescribed inappropriately, according to Associate Professor Jane Smith of Bond University. Heart disease is a common problem, causing 16% of the total disease burden in Australia – second only to cancer. However treatment with statins should be focused on those at high risk.

Writing in the December issue of Australian Prescriber, Professor Smith says it is likely that doctors are over-prescribing medicines called statins for patients at low risk of heart disease. In her view, treatment should focus on people who are more likely to benefit from treatment.

In people at high risk, especially those who have heart disease, statins lower cholesterol and the chance of heart attack. But in other people, it may not be beneficial to focus only on high cholesterol to determine whether statins should be used.

“Patients and health providers tend to focus on cholesterol. A possible consequence of this is that statins are now the most prescribed medicines in Australia,” says Professor Smith.

“Many other factors influence the risk of developing heart disease. These include smoking, high blood pressure, diabetes and obesity.”

According to the author, Australians are living longer, but greater rates of physical inactivity, obesity and diabetes all threaten this trend.

“The risk of developing heart disease can also be reduced by modifying lifestyle factors such as exercising regularly, stopping smoking, ensuring good nutrition, reducing alcohol intake and reducing stress levels.”

What is less clear is whether people with a low risk benefit from treatment with statins.

“Statin treatment in those with a lower risk offers limited benefit and may result in harm such as cataracts or muscle damage,” says Professor Smith.

“Guidelines recommend against routine statin treatment for those with a lower risk. Apart from those with extreme elevations of lipids, assessment of risk should look at multiple factors, not just cholesterol.”

Anyone with questions or concerns about their risk of heart disease or the medicines they have been prescribed should speak to their doctor.

To read the full article and others, visit


Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by NPS, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is published every two months, in hard copy that is distributed to health professionals free of charge, and online in full text at