12.02.14
NICE halves threshold for prescribing statins
Statins could be offered to 12 million adults in an effort to cut the risk of strokes and heart attacks. NICE has published new draft guidance on the use of the medication to prevent cardiovascular disease (CVD) – the leading cause of death in England and Wales.
The threshold for people at risk of developing CVD within the next ten years being offered preventative treatment will be lowered from 20% to 10%. NICE stated that risk factors such as smoking, drinking, exercise and diet should be managed before patients are offered high intensity statin therapy.
Long-term ill-health caused by CVD is increasing, and disproportionately affects people in socially deprived areas with low incomes. About seven million people in Britain are taking statins, costing the NHS £450m a year.
The new guidance calls for GPs to use a systematic strategy, the QRISK2 assessment tool, to identify people aged 40-74 with a high risk of developing CVD.
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“We now want to hear views on this draft guidance which recommends that people with a 10% risk of developing CVD within 10 years are offered statins.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% risk of developing CVD and advise them appropriately.
“As well as taking statins, people with raised cholesterol levels and high blood pressure should reduce the amount of foods containing saturated fat they eat (meat, cheese and milk), they should exercise more and control their blood glucose levels by reducing their intake of sugar and by losing weight. They should also stop smoking.”
But some have cautioned against greater prescription of statins. Dr John D Abramson, clinical lecturer in primary care, from Harvard Medical School, said: “I think we have become victims of the drug companies. All the research is funded by them, and the really important message – that reducing your risk of heart disease is best done by an improved diet and lifestyle – is getting crowded out.”
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