National Institute for Health and Clinical Excellence (NICE)
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Thousands more could be offered statins

Thousands more people could be prescribed statins to help lower cholesterol levels and reduce the risk of heart attacks and strokes, under draft guidance.

In an update to the existing guideline on lipid modification, NICE is proposing that the threshold be halved for offering statins to people to prevent cardiovascular disease (CVD), the cause of 1 in 3 of all deaths in the UK.

Currently, only people with a 20 per cent or greater 10-year risk of developing CVD are offered statins. Draft guidance now recommends offering statins to people who have a 10 per cent or greater 10-year risk of developing CVD.

As many as 7 million people in the UK are currently believed to take statins, at an estimated annual cost of £450 million.

GPs should estimate the level of risk among their patients using the QRISK2 assessment tool and 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.

NICE had previously recommended the US Framingham risk tool before withdrawing advice about which risk assessment tool to use in February 2010. New evidence has suggested that QRISK2 is a more accurate CVD risk tool particularly among ethnic populations.

Patients with type 2 diabetes should, however, have their risk assessed using the UKPDS risk tool.

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 higher strength 80mg dose of atorvastatin.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE 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 per cent risk of developing CVD within 10 years are offered statins. Doctors will need to make a judgment about the risks to people who have a less than 10 per cent risk of developing CVD and advise them appropriately.

“As well as taking statins, people with raised cholesterol levels and high blood pressure should reduce the amount of foods containing saturated fat they eat, they should exercise more and control their blood glucose levels by reducing their intake of sugar and by losing weight. They should also stop smoking.”

Registered stakeholders, such as professional and government organisations, patient and carer groups, and companies, have until the 26 March 2014 to comment on the draft guidance.

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