Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4356 (Published 17 July 2014) Cite this as: BMJ 2014;349:g4356

Rapid Response:

Two questions for the NICE Guideline Development Group:

Re. Cardioprotective diet for prevention of CVD
o -Reduce saturated fat intake from animal sources: this also reduces monounsaturated fat levels
o -Replace saturated and monounsaturated fats with olive oil, rapeseed oil, or spreads based on these oils, and use them in food preparation

The NICE guidelines state (New recommendations.) [Based on low and very low quality randomised controlled trials and the experience and opinion of the GDG] (1)

May I enquire as to the source of scientific evidence this guidance has been based on?

Secondly guidelines have been extended on statin use within diabetes management:

In people with type 1 diabetes
• Offer atorvastatin 20 mg for the primary prevention of CVD to people with type 1 diabetes who are over 40 years, have had diabetes for more than 10 years, have established nephropathy, or have other CVD risk factors. (New recommendation.) [Based on the experience and opinion of the GDG]
In people with type 2 diabetes
• Offer atorvastatin 20 mg for the primary prevention of CVD to people with type 2 diabetes who have a 10% or greater 10 year risk of developing CVD (estimated with QRISK2). (New recommendation.) [Based on high to moderate quality evidence from randomised controlled trials, cost effectiveness analysis, and the experience and opinion of the GDG] (1)

No advice has been offered concerning the possibility of statin related adverse effects within diabetes management. (2) Where is the evidence base for prescribing statins in Type 1 diabetes? (An autoimmune disease). Is it not the case that evidence has been extrapolated from statin use in Type 2 diabetes to this entirely different disease? Further information and studies in statin use in type 1 diabetes should be a priority, as the evidence base is obviously poor.

(1) Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance ilvia Rabar, senior research fellow and project manager1, Martin Harker, senior health economist1, Norma O’Flynn, clinical director and guideline lead1, Anthony S Wierzbicki, professor of cardiometabolic disease 2 On behalf of the Guideline Development Group 2014;349:g4356 http://www.bmj.com/content/349/bmj.g4356
(2) Do statins cause diabetes? Goldstein MR1, Mascitelli L. Curr Diab Rep. 2013 Jun;13(3):381-90. doi: 10.1007/s11892-013-0368-x.http://www.ncbi.nlm.nih.gov/pubmed/23456437

Competing interests: No competing interests

23 July 2014
Jane E Collis
Independent Health Resercher
none
Kenilworth Warwickshire UK