NICE has recently updated its 2006 guidelines on lipid modification and it now recommends that the threshold for starting preventative treatment for cardiovascular disease (CVD) should be halved from a 20% risk of developing CVD over 10 years to a 10% risk.
This now means that up to 4.5 million people could now be eligible for statins. It has been estimated that changing this threshold could lead to a reduction of up to 28,000 heart attacks and 16,000 strokes each year.
NICE recommends that GPs start statin treatment for the primary prevention of CVD with atorvastatin 20 mg. Patients with established CVD, type 1 diabetes or type 2 diabetes should be offered a 80mg dose of atorvastatin.
Although the guidelines clearly state that lifestyle measures should be tried first, we are all fully aware of the difficulties the majority of our patients will have adhering to these. This means that most people with at least 10% CVD risk will need to take atorvastatin 10mg every day for the rest of their lives.
Some experts are very positive about these guidelines and state that there is plenty of evidence now available to support their use. In addition, they have been proven to be cost effective and have a favourable risk:benefit ratio.
Many GPs and healthcare professionals do not feel quite so positive about these guidelines. However, experts state that people should be encouraged to work out their QRISK2 score themselves, either online or via an App, rather than their GP working it out for them. Even if this is done, many more people are likely to need appointments to discuss the possibility of them being prescribed a statin.
The implementation of these guidelines could potentially create much more work to already very stretched primary care services. In addition, there are some real concerns about "medicalising" a nation and encouraging patients to take pills rather than change their unhealthy lifestyle. The BMA have even stated that these guidelines would "distort health spending priorities and disadvantage other patients".
I am personally concerned that the “worried-well” will be queuing at the surgery doors for their statins, whereas the overweight (or obese), sedentary smokers will disregard any perceived benefit of taking a statin and continue their unhealthy lifestyle regardless.