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NICE says far more people should take statins

Guidance proposes cutting threshold for 10-year CVD risk to 10%

Louise Prime

Wednesday, 12 February 2014

Far more people should be taking statins to stave off cardiovascular disease, the National Institute of Health and Care Excellence recommends in draft guidance published today. NICE also renews its call for people to alter their lifestyle to reduce their CVD risk.

NICE’s previous guidance, from 2008, said that people with a 10-year CVD risk of at least 20% should be taking statins, and about seven million people across the UK are currently thought to be taking the drugs, at a cost of £450m – but cardiovascular disease remains the country’s leading cause of death. NICE’s new guidance says that people’s CVD risk should be assessed using the QRISK2 calculator, and proposes dropping the threshold for taking statins to a 10-year CVD risk of 10% or more.

NICE says it updated its guidance partly because of new evidence on CVD risk assessment tools, as well as the price reduction in many statins as they come off-patent. It says its proposed changes will mean more lives can be saved.

NICE also points out in its revised guidance that standard CVD risk scores underestimate risk in certain groups of people, including those: treated for HIV; with serious mental health problems; taking medicines that can cause dyslipidaemia (such as antipsychotic medication, corticosteroids, or immunosuppressant drugs); with stage 1 or 2 chronic kidney disease; or who have autoimmune disorders such as systemic lupus erythematosus (SLE), rheumatoid arthritis and other systemic inflammatory disorders.

Professor Mark Baker, director of NICE’s Centre for Clinical Practice, stressed that people already at higher risk because of raised cholesterol levels and hypertension should cut down on dietary saturated fat and sugar, exercise more, lose weight and stop smoking. He 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 judgement about the risks to people who have a less than 10% risk of developing CVD and advise them appropriately.”

The public consultation on the guidance closes on 26 March.

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