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NICE recommends wider use of statins in draft guidelines

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1518 (Published 12 February 2014) Cite this as: BMJ 2014;348:g1518
  1. Jacqui Wise
  1. 1London

The risk threshold for starting treatment with statins to prevent cardiovascular disease should be halved, says new draft guidance from the National Institute for Health and Care Excellence.1

The guidance, which is out for public consultation until 26 March, recommends that doctors use the QRISK2 assessment tool to identify people aged 40-74 who are likely to be at high risk of developing cardiovascular disease. It says that the threshold for starting preventive treatment with statins should be halved from a 20% risk over 10 years to a 10% risk.

NICE said that it was updating its guidance to reflect changes in the price and availability of generic statins and because of new evidence on cardiovascular risk assessment tools.

Death rates from cardiovascular disease have halved since the 1970s, but it is still the leading cause of death in England and Wales. In 2010 around 180 000 people died from cardiovascular disease, 80 000 of whom died from coronary heart disease and 49 000 from strokes.

Although death rates are falling, morbidity seems to be rising, with significant cost implications for the NHS. Cardiovascular disease was estimated to cost the NHS in England £7.9bn (€9.5bn; $13bn) in 2010. NICE pointed out that the prevalence of cardiovascular disease was strongly associated with low income and social deprivation and showed a north-south divide, with higher prevalence in the north of England.

Mark Baker, director of NICE’s Centre for Clinical Practice, said, “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.”

Before starting statin treatment, the guidance recommends that doctors take at least one lipid sample and measure total cholesterol, HDL cholesterol, non-HDL cholesterol, and triglyceride concentrations. It says that a fasting sample is not needed.

Doctors should prescribe atorvastatin 20 mg for the primary prevention of cardiovascular disease and atorvastatin 80 mg for patients with established cardiovascular disease, type 1 diabetes, or type 2 diabetes.

The guidance also says that standard cardiovascular risk scores underestimate risk in some groups of patients, such as people being treated for HIV and people with serious mental health problems, with stage 1 or 2 chronic kidney disease, or with autoimmune disorders such as systemic lupus erythematosus. Scores also underestimate risk in people taking drugs that can cause dyslipidaemia, such as antipsychotics, corticosteroids, and immunosuppressants.

Notes

Cite this as: BMJ 2014;348:g1518

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