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UK NICE Guidelines Advise for Wider Use of Statins

CVD preventive treatment should also be started much earlier in patients with lower risk…. 

The UK’s National Institute for Health and Care Excellence (NICE) recently issued a draft for public consultation that recommends physicians consider many more people to be at risk for cardiovascular disease (CVD). CVD, which is composed of conditions such as heart disease, stroke, and peripheral arterial disease, collectively causes 1 in 3 deaths in the United Kingdom. NICE is recommending that the threshold for starting preventive treatment of these conditions should be halved from a 20% risk of developing CVD over 10 years to a 10% risk.

CVD develops when fatty substances (composed of cholesterol, calcium, and fibrous tissue) build up in the coronary arteries. With age, these fatty deposits can form into plaques on the arterial walls and severely narrow them. Depending on where the disease develops, it can be called coronary heart disease (heart), stroke (neck or brain), or peripheral arterial disease (pelvis and legs). Many risk factors can contribute to a person developing CVD. Some risk factors cannot be changed including family history, age, sex, and ethnicity. There are also modifiable risk factors including smoking, alcohol consumption, exercising and diet. The draft guidance issued by NICE recommends that risk factors which can be addressed should be managed appropriately.

Patients are assessed for their risk of developing CVD using a risk calculator. This calculator considers 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. This percentage is where NICE now is recommending a 50% decrease for when physicians initiate preventative treatment.

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% 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% 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 (meat, cheese and milk), 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."

The NICE guidance also identifies that standard CVD risk scores will underestimate risk in people with certain underlying conditions such as: diabetes, stage 1 or 2 chronic kidney disease, certain autoimmune disorders, mental health disorders, and people taking medicines which can cause dyslipidemia. People who fall into one of these categories will need their risk assessed on a case by case basis.

Although much progress has been made in the battle against CVD (death rates have been halved from 40 years ago), the disease remains prevalent and a leading cause of death. NICE is updating its 2008 guidelines to respond to the persistent disease and reflect changes in the price and availability of generic statins.

Practice Pearls:

  • CVD is a collective group of disorders caused by plaque build-up and subsequent narrowing of the arteries
  • A 10 year risk assessment can be calculated from modifiable risk factors to determine the likelihood of an individual developing CVD
  • NICE is now recommending this risk percentage be reduced by half (20% to 10%) to determine when initiation of statin medication be used

"NICE Advises Much Wider Use of Statins in Draft Guidance." NICE. N.p., n.d. Web. 13 Feb. 2014. http://www.nice.org.uk/newsroom/pressreleases/NICEAdvisesMuchWiderUseOfStatinsInDdraftGuidance.jsp