Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. My name is Dr. Warrick Bishop and thank you for joining me on my podcast station. Today I'd like to take a moment to talk about the availability of the statins for cholesterol lowering in Australia. Now in Australia we have the PBS which defines how drugs are funded. through the community. PBS stands for the Pharmaceutical Benefits Scheme. And of course the government are responsible for defining the PBS. They gain insight from panels that they put together and get recommendations. The PBS of course is extremely important because the Pharmaceutical Benefits Scheme represents an enormous amount of money. and cost to the government and therefore to taxpayers. So it has to be fairly closely regulated. What I would like to discuss today is something that I only found out about just in the last couple of weeks, and that is that the eligibility criteria for cholesterol-lowering drugs, specifically the statins, has recently changed. Now, the last time that there was a PBS eligibility criteria established for the cholesterol lowering drugs was in October of 2006. So we're talking 12 years ago. Back then, as you can imagine, the statins were still branded and still under patent and therefore produced by companies who were able to charge top dollar because they owned the patent and therefore owned the drug. Well, since that time, the patents have expired and many of the common cholesterol-lowering tablets are being made by manufacturers without the patent and therefore are called generic. So they're the exact same primary compound, but made by other companies. We call these generics. Well, back in 2006, you were able to get a cholesterol-lowering drug if you had coronary heart disease, which had become symptomatic. or cerebrovascular disease, a stroke if it had become symptomatic, or blocked arteries in the legs if they were symptomatic. I'm making it really clear that the guidelines or the eligibility criteria stipulated that people had to have symptomatic issues to be able to be prescribed these tablets. This will become very important. And I'll mention it again at the end, but this becomes very, very important if we're wanting to treat cholesterol in someone who hasn't yet had a problem with their heart. And this is one of the key areas that I'm particularly interested in, which is heart attack prevention. The other criteria that would allow you to access a cholesterol-lowering tablet includes diabetes with loss of protein in the urine. if you're diabetic and of either Aboriginal Australian or Torres Strait Islander origin, if you're a diabetic and over 60 years of age, if there's a family history, again, of symptomatic problems before 55 years of age in two first-degree relatives, and a first-degree relative is your immediate family, mother, father or sibling, or a family history of... coronary artery disease that has become symptomatic before the age of 45 in one or more first degree relatives. Now they're all the criteria that allow you in 2006 to just recently would have allowed you to access a statin agent or a lipid lowering agent. Now there are some other categories and I'm going to mention them just really quickly because it's more confusing than helpful but it includes people with diabetes who are otherwise not including what I've just mentioned with a total cholesterol of more than 5.5. Aboriginals or Torres Strait Islanders with hypertension and a cholesterol of greater than 6.5 or a total cholesterol of 5 greater than 5.5 and an HDL less than 1. And it goes on like that. There's a lot of... subcategories, which are all a little bit particular, quite specific because they designate high-risk populations, but none of them necessarily represent the average bloke in the street or woman in the street who may not yet have any symptoms whatsoever and may well benefit from cholesterol lowering. Well, the reason why all this is so important, the reason why I've been keeping an eye on it, and the reason I was somewhat surprised that this had slipped under my radar, is that on the 1st of October 2018, there was a change in the Pharmaceutical Benefits Scheme eligibility criteria for statins. And that eligibility criteria has now... completely been removed. Other cholesterol-lowering tablets still have eligibility criteria because they're quite expensive and not yet being produced as generics, therefore lowering their cost. But the statins are now cheap and the PBS eligibility criteria have now been removed. Well, why is that important? The reason that is important is because In my own practice, I've seen patients who, in the October 1, 2006 eligibility criteria, would not have fulfilled the criteria for prescription of statins. Yet, I may well have imaged their heart arteries to see the health of their arteries and demonstrated high or very high-risk features, which almost certainly would mean... this individual would benefit from therapy. This has meant that I've had to ask those particular individuals to self-fund. Otherwise, we would be contravening the PBS eligibility criteria, and that, of course, is illegal. So, we are now moving into 2019 in a situation where if we see... build up a plaque in the arteries that will clearly benefit from cholesterol lowering, then we are, in Australia, able to use the statin drugs without any limitation other than what we believe is the appropriate risk and benefit for that individual clinically. And I have to say, I think that's a great step forward. This now means we can be treating people before they become symptomatic, because really, let's face it, if we've waited until they develop symptoms, that's pretty late in the game. So I think this is a really good news story. I think it's really important that that information gets out there. I'm in this area and interested in this area, and I was surprised. surprised that this had slipped under my radar so if you do listen to this can you please share it around share it with your friends because they may be paying for their own cholesterol layering agents at the moment and importantly if you've got any friends who are doctors please share it with them because this information really does need to get out there and one of the really important aspects of trying to be preventative is that we can now give therapy before symptoms occur. And up until just recently, the understanding in Australia has been we've had to pretty well wait till someone's had symptoms. So no more limitations on prescription of statins in Australia. Great news story for those people who have the opportunity to benefit from that. I hope this makes some sense. Please share this with people as you see fit. But that message needs to get out. Thank you for listening. And I hope you found this an interesting podcast. I've got many others. And if you do have any suggestions on topics, please send them through and we'll see what we can do. So thank you once more for listening. I wish you the very best. Take care and bye for now. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.