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Article Excerpt
Byline: DAVID T. NASH, MD
The British National Health Service provides all treatments and procedures with no out-of-pocket costs-but often with significant delay. To reduce health system costs, the British government has decided to permit over-the-counter (OTC) sale of simvastatin, which had lost patent protection in the United Kingdom. Because the patient makes the decision to buy and take the pill, it is no longer the government's responsibility to pay for it. British patients do not need a prescription to purchase simvastatin, but they are provided with educational material that describes contraindications, such as pregnancy, liver disease, allergies, and interacting medications.
Who, then, is likely to buy the statin? The persons most likely to benefit are those at intermediate risk for vascular disease (ie, less than 20% risk in 10 years). Many lipid specialists in the United States recommend treating patients at lower risk depending on a variety of factors, including patient preference, family history of cardiovascular disease, and perhaps inflammatory markers.
There is growing interest in similar plans to make statins available OTC in the United States. The aim is to...
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