Cholesterol lowering drugs should be offered only as a last resort, a government funded body has reported. Patients should first be encouraged to stop smoking, take exercise and improve their diet.

These other options are far more cost effective than statins, the family of cholesterol lowering drugs, says the NHS Centre for Reviews and Dissemination. If drugs do need to be used, doctors should prescribe aspirin and beta blockers first, which are also cheaper.

Only if a patient still has a high cholesterol level after trying all the other treatments should a statin be considered. And, it points out, a high cholesterol level is in any case a poor indicator of who will develop heart disease. Most heart problems occur in people who do not have raised cholesterol.

The centre is also critical of pharmaceutical companies which are reluctant to launch lovastatin in the UK. Lovastatin is an unbranded (generic) and therefore cheaper statin. Prescribing it in place of the branded statins now being used could save the government a substantial proportion of the £113m it spends each year on cholesterol lowering drugs. Lovastatin is due for launch in most other countries next year (Medical Monitor, March 4, 1998).