'Is one wonder drug as good as the other?


Q. My wife takes a statin tablet to lower her cholesterol. For reasons of economy, it has been suggested that she change from Lipitor (also known as atorvastatin) to simvastatin. Is there any difference in their effects?

A. Statins have been described by the British Medical Journal as "one of the great success stories of preventive medicine". They are credited with preventing heart attacks, strokes and illnesses linked to high cholesterol levels. In 2004, the NHS spent £738m on statins. The two main statin drugs prescribed - simvastatin and atorvastatin - account for much of this. The National Institute for Health and Clinical Excellence suggests that 14 per cent of adults should take statins. The usual simvastatin dose is either 20mg or 40mg a day; for atorvastatin it is 10mg or 20mg a day. Simvastatin (no longer protected by a patent) is much cheaper. Although you need to take more simvastatin for an equivalent effect, the drugs do much the same thing and are equally safe and effective. As with all drugs, some patients will get side effects on one but not another. Every time a patient is started on simvastatin rather than atorvastatin, the NHS expects to save about £1,000 over five years. Changing patients from atorvastatin to simvastatin could save the NHS £2bn in five years. The argument for using simvastatin seems pretty convincing to me.


Q. My mother has been diagnosed with osteo-malacia - her bones are too "soft". What is the difference between brittle and soft bones?

A. Osteomalacia is the adult equivalent of rickets. It usually affects the frail elderly, and in the UK it is often diagnosed in people of South Asian origin. Normal bone development depends on plenty of calcium, phosphorus and vitamin D. If any of these are in short supply, the bones become soft; in osteoporosis, the bones become thin and brittle. Osteomalacia causes bone and muscle pain, usually in the legs and back. A lack of vitamin D is the most common cause. Humans get some vitamin D from diet, but most of it is made in the skin in response to sunlight exposure. Dark-skinned people make less vitamin D than fair-skinned. Dietary sources of vitamin D include margarine, eggs and fish such as herrings, mackerel, sardines and kippers. The Arthritis Research Campaign has a booklet on osteomalacia (08708 505 000; www.arc.org.uk).

Please send your questions and suggestions to A Question of Health, The Independent, Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions

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A yoga teacher explains how to prevent dizziness:

To help combat dizziness when standing upright after bending low, use a yoga technique. Take a deep inhalation as you come up, slightly lifting the head so you are looking forward/up, eyes open, of course.