More people in England could be offered statins, following newly published draft guidance from NICE.
Doctors could offer thousands of patients the option of taking statins – whilst also ensuring they receive lifestyle advice, under the new proposed guidance.
NICE says while the risk threshold at which statins should be offered to prevent heart disease and strokes remains unchanged, they can now also be considered for people at a lower threshold.
NICE estimates this new recommendation will mean that, on average, for every 1,000 people with a risk of 5% over the next ten years who take a statin, about 20 will not get heart disease or have a stroke because of the drug.
The figure doubles to 40 for people with a risk of 10%, and for people with a risk of 20% NICE estimates that, on average, about 70 people would not get heart disease or have a stroke in the next 10 years.
Existing guidelines say people with a 10% or higher risk over 10 years of a cardiovascular event should be offered a statin.
However, this could now change after the independent committee updating the NICE guideline on cardiovascular disease (CVD) risk assessment and reduction considered new evidence on the side effects and safety of statins.
The draft guideline recommends doctors consider atorvastatin 20mg for the primary prevention of CVD for people with a 10-year risk of less than 10%, where there is patient preference for taking a statin or concern that risk may be underestimated.
The committee says focusing on increasing uptake among people with the highest risk of CVD events would have more impact, which is why the draft guidance says that, while people at lower risk can be considered for statin therapy, people at a higher risk should continue to be offered statins.
NICE recommends assessing people using the QRISK3 calculator to calculate their risk of developing cardiovascular disease.
Paul Chrisp, director of the Centre for Guidelines at NICE, said: “What we’re saying is that, for people with a less than 10% risk over 10 years of a first heart attack or stroke, the decision to take a statin should be left to individual patients after an informed discussion of benefits and risks.
“The evidence is clear, in our view, that for people with a risk of 10% or less over 10 years, statins are an appropriate choice to reduce that risk.
“We are not advocating that statins are used alone. The draft guideline continues to say that it is only if lifestyle changes on their own are not sufficient, and that other risk factors such as hypertension are also managed, that people who are still at risk can be offered the opportunity to use a statin, if they want to. They don’t have to, and their decision should be informed by an understanding of the risks and tailored to their values and priorities.
“Put simply, it is the responsibility of GPs to explain the ways in which people can reduce their risk of cardiovascular disease, presenting all the options promoted by the draft guidance, including lifestyle changes, blood pressure control, avoidance of diabetes and cholesterol (lipid) lowering, and allow patients to make their own decisions.”
NICE is also updating its patient decision aid (PDA) to help people make informed decisions about taking a statin for primary prevention of CVD.
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