GPs are refusing to offer tens of thousands of eligible patients a twice-a-year injection that could slash their risk of heart disease and dementia, experts claim.
The jab has been shown to reduce by half the levels of so-called ‘bad’ cholesterol – a fatty substance known as LDL that can build up in the blood vessels and drastically increase the risk of a heart attack or stroke by blocking the flow of blood.
But just 7 per cent of the 300,000 NHS patients who stand to benefit from it have received it since it was approved in 2021, as arguments raged over its long-term safety and the level of patient monitoring that GPs are required to carry out.
And now a landmark study has concluded that high LDL levels also raise the risk of dementia, and that lowering it to a healthy level reduces the risk of the degenerative brain disease by 26 per cent.
The results of the South Korean research, published in the Journal of Neurology, Neurosurgery and Psychiatry, now suggests that cholesterol-lowering drugs may be crucial in the fight against the UK’s two most deadly diseases – heart disease and dementia, which together kill more than 200,000 people every year.
The low take-up of the drug, inclisiran, also known under its brand name Leqvio, is due to a long-running stand-off between the NHS and both the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) which are refusing to allow GPs to prescribe it.
The organisations – two of the UK’s largest bodies representing doctors – argue that their members don’t have enough time to offer the drug as patients on it must be carefully monitored for long-term side effects, and also claim that there’s not enough proof of its effectiveness and safety.
It means that most inclisiran prescriptions are written by a specialist, forcing some patients to travel hundreds of miles to see a relevant doctor or wait as long as a year for an appointment.
In 2022, Mariella Frostrup revealed she had heart disease and was ‘on medication you inject twice a year’ saying it was ‘a life-saver as statins didn’t work for me’
Ordinarily, GPs and cardiologists prescribe statins to anyone with high cholesterol and deemed to have more than a 10 per cent risk of having a cardiovascular event, such as a heart attack or stroke, over the next decade.
The cheap daily tablets are taken by up to 8 million Britons. But research has shown half of those taking them fail to reach healthy cholesterol levels after two years.
Some simply stop taking the medication, while others are unable to take a high enough dose to make it effective – often blaming side effects such as muscle aches. Inclisiran is designed to be taken with statins or other cholesterol-lowering medication to sufficiently reduce levels swiftly.
In 2022, broadcaster and menopause campaigner Mariella Frostrup revealed she had heart disease and was ‘on medication you inject twice a year’ saying it was ‘a life-saver as statins didn’t work for me’. Although she didn’t name the drug, she said it ‘dramatically affected my cholesterol’.
Inclisiran was approved for high-risk patients by the National Institute for Health and Care Excellence (NICE) after trials showed it could cut LDL levels by almost half. The NHS regulator also highlighted a need for more cholesterol-lowering medicines to reduce the number of heart attacks and strokes the NHS tackles – which account for about 100,000 hospital admissions a year.
However, the RCGP and BMA argue it is still unclear how much inclisiran reduces heart attack and stroke numbers and its long-term side effects. According to Dr Michael Mulholland, RCGP honorary secretary, there are also ‘insufficient resources’ for GPs to prescribe inclisiran and monitor patients for potential side effects.
As a result, both groups say it should be offered only by hospital specialists and not GPs. They also do not intend to change their position until long-term data is published, which is due in 2026.
However, other experts say it is crucial that GPs prescribe the jab.
GPs are refusing to offer tens of thousands of eligible patients a twice-a-year injection that could slash their risk of heart disease and dementia, experts claim
‘I offer my cardiovascular disease patients inclisiran, but they have to be referred to my hospital clinic in order to see me,’ says Professor Kausik Ray, a consultant cardiologist at Imperial College London and lead investigator on a major inclisiran trial.
‘GPs have an important role to play in preventing serious disease in the community. This includes helping patients manage their cholesterol with a range of treatments, such as inclisiran.’
However, in many cases, eligible patients are not told about inclisiran until it is too late.One patient who believes he should have been offered the jab is Nick Stewart, a 56-year-old electronics worker from Hampshire. He was given statins after a blood test revealed he had elevated LDL levels.
However, he developed severe muscle aches after starting on the daily tablets – an uncommon but well-documented side effect. So Nick came off them, but his GP did not offer an alternative treatment.
Then, in 2023, Nick suffered a heart attack. Following his recovery from surgery, he sought out a private heart specialist to help him in his recovery and reduce the risk of another attack.
It was only then that Nick found out about inclisiran.
He says: ‘I definitely should have done more to lower my cholesterol before the heart attack but until then I didn’t know there were any options other than statins.’
‘My most recent blood test shows that my LDL levels have halved since I started on inclisiran. Hopefully this will prevent any future heart issues.’
Now experts are calling on GPs to offer it to eligible patients.
‘High cholesterol levels are a risk factor for both diseases of the heart and brain, and we have effective drugs to lower cholesterol we could be giving patients today,’ says Prof Ray. ‘Nowhere near enough patients in the country are being offered inclisiran.’
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