Controversial new guidelines aimed at massively extending the use of cholesterol-lowering statins were being unveiled today.
The UK National Institute for Health and Care Excellence said it had decided to press ahead with advising doctors to offer the drugs to people with a very slightly increased risk of developing heart disease or suffering stroke.
The organisation has advised that the threshold for starting preventive treatment of heart attacks, strokes and peripheral arterial disease should be halved from a 20% risk of developing them over 10 years to a 10% risk.
NICE clinical guidelines CG181 on lipid modification says that priority should be given to stopping smoking, reducing alcohol consumption, taking exercise and eating a healthy diet but high intensity statin treatment should be offered once those issues have been dealt with.
The change in policy comes just a month after some medical experts warned the then Health Secretary Jeremy Hunt and NICE that lowering the threshold would result in the “medicalisation of five million healthy individuals”.
Opponents had called on NICE to postpone making a decision on the guidance for statins until independent experts had examined in detail the data because the plans had come out of studies that had been funded by the pharmaceutical industry.
However, Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “To make progress in the battle against heart disease and stroke, we must encourage exercise, improve our diets still further, stop smoking, and where appropriate offer statins to people at risk.
“Doctors have been giving statins to ‘well people’ since NICE first produced guidance on this in 2006. We are now recommending the threshold is reduced further. The overwhelming body of evidence supports their use, even in people at low risk of cardiovascular disease.
The effectiveness of these medicines is now well proven and their cost has fallen.”
NICE recommends that people are assessed using the QRISK2 calculator for their risk of developing heart disease to provide a percentage risk of developing CVD in the next 10 years.
Professor Peter Weissberg, medical director at the British Heart Foundation, welcomed the publication of NICE clinical guidelines CG181 on lipid modification.
“Too many people die from cardiovascular disease, and these new guidelines are part of continuing efforts to prevent heart attacks and strokes,” he said.
“Doctors will now be able to offer a statin to people at a lower risk, but their prescription is not mandated. Just as important is the emphasis on trying lifestyle changes before considering treatments with drugs.
“Crucially, the guidelines emphasise that preventive strategies should be based on each individual’s risk and needs with a personalised game-plan to help reduce their risk of cardiovascular disease.”
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