The content of this website is intended for healthcare professionals only

Millions more patients are now eligible for statins

NICE halves the cardiovascular risk threshold for GPs to prescribe statins to patients

Ingrid Torjesen

Friday, 18 July 2014

The National Institute for Health and Care Excellence has told doctors that they should consider more patients to be at sufficient cardiovascular risk to warrant the prescription of statins.

The NICE clinical guideline on lipid modification published today advises that the threshold for starting preventive treatment of these conditions should be halved from a 20% risk of developing cardiovascular over 10 years to a 10% risk. Prevention includes stopping smoking, reducing alcohol consumption, taking exercise and eating a healthy diet. Once these factors have been addressed, the guidance says high intensity statin therapy should be offered because the other factors for increasing risk cannot be modified, these include age, sex, ethnicity, and family history.

NICE recommends that people are assessed (using the QRISK2 calculator) for their risk of developing cardiovascular disease using measurements including whether or not they smoke, their cholesterol levels, blood pressure, and body mass index. The calculator then provides a percentage risk of developing CVD in the next 10 years. Cardiovascular disease is responsible for one in three deaths in the UK (180,000 each year).

Up to 4.5 million people could be eligible for statins under the lower threshold, and NICE estimates that offering statins to all eligible people could help to prevent up to 28,000 heart attacks and 16,000 strokes each year.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, says: “Doctors have been giving statins to ‘well people’ since NICE first produced guidance on this in 2006. We are now recommending the threshold is reduced further. The overwhelming body of evidence supports their use, even in people at low risk of cardiovascular disease. The effectiveness of these medicines is now well proven and their cost has fallen.

“The weight of evidence clearly shows statins are safe and clinically and cost effective for use in people with a 10% risk of CVD over 10 years.

“We’re not saying that everyone with a 10% or greater risk of CVD within 10 years needs to take a statin. The guideline recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between benefits and risks.”

By recommending a systematic approach to identifying those at risk of CVD, the guideline will enable people to access treatments to address that risk by reducing their cholesterol levels, he added. It will also provide further clarity for practitioners in primary and secondary care about how to manage patients both with and without pre-existing cardiovascular disease.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470