NICE proposes wider use of statins

MILLIONS more patients could be prescribed statins to prevent cardiovascular disease under new draft guidance from NICE.

In an update to its lipid modification guidance NICE proposes lowering the threshold for offering statins to patients by half from a 20 per cent risk of developing CVD over 10 years to a 10 per cent risk.

As many as 7 million people in the UK are currently believed to take statins, at an estimated annual cost of £450 million. The new recommendations could extend treatment to millions more patients.

The new draft guidance also recommends that GPs start treatment for the primary prevention of CVD with atorvastatin 20 mg (replacing simvastatin). Patients with established CVD, type 1 diabetes or type 2 diabetes should be offered a higher strength 80mg dose of atorvastatin.

GPs should estimate the level of risk among their patients using the QRISK2 assessment tool and which incorporates data such as smoking history, cholesterol levels, blood pressure and body mass index and provides a percentage risk of developing CVD in the next 10 years. NICE had previously recommended the US Framingham risk tool but new evidence suggests that QRISK2 is a more accurate, particularly among ethnic populations.

Patients with type 2 diabetes should, however, have their risk assessed using the UKPDS risk tool.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: "Smoking, high blood pressure and raised cholesterol levels are big causes of cardiovascular disease, especially in people with more than one of the factors. But the risk is measurable and we can substantially reduce someone's chance of a heart attack, angina, stroke and the other symptoms of cardiovascular disease by tackling the risk factors.

"People should be encouraged to address any lifestyle factors such as smoking, drinking too much or eating unhealthily. We also recommend that statins are now offered to many more people - the effectiveness of these medicines is now well proven and their cost has fallen.

"We now want to hear views on this draft guidance which recommends that people with a 10 per cent risk of developing CVD within 10 years are offered statins. Doctors will need to make a judgment about the risks to people who have a less than 10 per cent risk of developing CVD and advise them appropriately."

Consultation on the draft guidance closes on 26 March.

Link

Draft guidance - Lipid modification (update)

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