Final NICE guidance could see 4.5m more Brits on statins
This article was originally published in Scrip
In final guidance, NICE has followed through with its plan to reduce the threshold for starting preventative treatment for cardiovascular disease (CVD) using statins, with the result that up to 4.5 million more people in the UK could be eligible.
NICE has lowered the threshold from a 20% risk of developing CVD over 10 years to 10%. The move, which is an update to the health watchdog's 2006 guideline on lipid modification, was first proposed in February (scripintelligence.com, 13 February 2014). NICE believes that offering statin treatment to all those eligible under the new threshold would prevent up to 28,000 heart attacks and 16,000 strokes per year. Currently, one in three deaths in the UK are caused by CVD.
Since statins like Lipitor (atorvastatin) fell off the patent cliff, the drugs have been relatively cheap. Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: "The effectiveness of these medicines is now well proven and their cost has fallen. The weight of evidence clearly shows statins are safe and clinically and cost effective for use in people with a 10% risk of CVD over 10 years."
NICE recommends that doctors start statin treatment for the primary prevention of CVD with atorvastatin. Patients with established CVD, type 1 diabetes or type 2 diabetes should be offered a higher dose. Meanwhile, the institute is still emphasizing that preventative lifestyle measures should be adopted first, such as exercise, healthy eating and stopping smoking.
It is yet to be seen how responsive doctors will be to the new guidelines. In the past many have expressed concerns about treating well people with a range of drugs that carry side effects including nausea, headaches, muscle and joint pain, visual disturbances and memory problems.
However, many academics have now spoken out to support the move. Notably, Sir Rory Collins, professor of medicine and epidemiology and co-director of the University of Oxford's Clinical Trial Service Unit and Epidemiological Studies Unit, said in March that doctors' reluctance to prescribe statins in line with NICE guidance was more potentially more damaging than the public's rejection of the MMR vaccine, which has been blamed for the rise in cases of measles (scripintelligence.com, 25 March 2014).