The West of Scotland Study was a landmark in preventive medicine. It was published in the early 1990s and was the first study to definitively show that statins (a family of cholesterol-lowering medicines) could prevent a first heart attack in people with high cholesterol. It randomized over 6,000 middle-aged men with high cholesterol who had never had a heart attack to either pravastatin (Pravachol) or placebo. In about 5 years of follow up, pravastatin clearly prevented heart attacks and saved lives. This launched multiple follow up studies, the development of many new statins, and the revision of national cholesterol standards to ever lower goals. Statins have become one of the most prescribed families of medications. You probably know someone on a statin. Tell them they partially owe their good health to the West of Scotland Study.
This week’s New England Journal of Medicine has a study that lets us visit with the same patients a decade later. The study followed the West of Scotland patients for another decade. During that time, they were just under their individual doctors’ care, and were not receiving any study medicine. In fact, about a third of the patients who were initially in the placebo group and about a third in the statin group were being prescribed statins by their doctors a decade later. The question this study asked was: would 5 years of statin therapy continue to have benefits that persisted after the original study ended?
The surprising answer was “yes”. Even a decade later, the group that was initially on pravastatin had a significantly lower rate of death from cardiovascular causes than the group that was initially on placebo. So five years of statin therapy prevents heart attacks and saves lives many years later, even after the medication is discontinued. That’s good stuff!
I’m trying to collect as many different examples of ways that doctors’ offices frustrate, inconvenience, or annoy patients. If you have an example (even if it was my office) of terrible customer service from a doctor’s office, please email it to me.