Saturday, 15 February 2014

NICE publishes new draft guidelines on statins use

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"Millions more people should be put on cholesterol-lowering statin drugs," BBC News reports. Draft guidance from the National Institute for Health and Care Excellence (NICE) has recommended that the drugs should be given to people with an estimated 1 in 10 or more risk of cardiovascular disease (CVD), which includes conditions such as heart disease and stroke.

At present, guidance for doctors on using statins to prevent CVD says that only people with a 20% or greater risk of developing CVD in the next 10 years should be offered the drugs.

NICE recommends that a specific statin called atorvastatin is used for both the prevention and treatment of CVD.

How is CVD risk assessed?

NICE recommends a risk assessment tool called QRISK2. This involves a series of calculations based on the following factors:

  • age
  • sex
  • body mass index (BMI)
  • ethnicity
  • family history of heart disease
  • whether you have one or more of the following chronic diseases: diabetes, kidney disease, high blood pressure, atrial fibrillation or rheumatoid arthritis
  • blood cholesterol levels
  • your current blood pressure

Doctors should offer "high-intensity" treatment with statins to healthy people who have a 10% or greater 10-year risk of developing CVD. "High-intensity" statins produce the largest LDL reduction at the lowest doses.

Healthy patients at risk of CVD should be offered 20mg of a drug called atorvastatin to cut the risk of CVD. In the previous guidelines, therapy was started using 40mg of a drug called simvastatin. Atorvastatin is a high-intensity drug, while simvastatin is medium intensity.

Where do the draft guidelines come from?
The updated draft guidelines have been published by NICE, the National Institute for Health and Care Excellence. They are a draft update of the guidelines on lowering cholesterol (or lipid modification) that were published in 2008.
These are draft guidelines that have been published for consultation with professional and government organisations, patient and carer groups, and companies. These stakeholders have until March 26 2014 to comment before NICE decides on its final recommendations.
Anyone who wishes to comment on the guidelines must first register as a stakeholder. To find out more, visit the NICE consultation page.

What is the rationale behind the new recommendations?
The recommended changes have been made on the basis of cost effectiveness. For example, NICE concluded that high-intensity treatment with 20mg atorvastatin is more cost effective than statin treatment using medium-intensity simvastatin.
It also reports that medium-intensity treatment is more cost effective compared with no treatment or low-intensity treatment at all realistic risk levels.
The guideline group decided to change the threshold from 20% risk to 10% risk by taking into account "the uncertainty regarding the frequency of adverse events in routine clinical practice, which may be higher than in clinical trials, the uncertainty around the magnitude of the effectiveness of statins and the accuracy of the QRISK2 tool itself, as well as the base case cost effectiveness results and sensitivity analyses".
The drugs have become cheaper in recent years, and their effectiveness is well proven, NICE notes.

The organisation has also pointed out that although death rates from CVD have halved since the 1970s and 1980s, CVD is the cause of one in three deaths in the UK. At present, as many as seven million people in the UK are believed to be on statins, at an estimated annual cost of £450 million.

What are the risks of taking statins?
Statins can have side effects, although the most common ones, while a nuisance, are not serious. They include stomach upset, headache and insomnia. Occasionally, the drugs can cause inflammation and damage to the muscles. Serious side effects, such as jaundice and visual disturbance, are rare.
Statins are not suitable for everyone. For example, they should not be taken if you have severe liver disease or blood tests suggest your liver may not be working properly.
Read more about the side effects of statins.

What can I do to cut the risk of CVD?
As NICE makes clear, statins are not the only option for treating high cholesterol. Alternative treatments include eating a healthy diet that is low in saturated fats, increasing the amount of omega-3 fatty acids in your diet, and other prescribed medications.
Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: "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."

Read more advice about lowering your cholesterol levels 
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

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Further reading

References (accessed 15th February 2014)

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