Updated guidance from NICE recommends that the use of statins for heart disease and strokes should be considered for people at a lower risk threshold.
The new guidance sates that the risk threshold for statins, which can prevent cardiovascular events such as heart disease and strokes, should remain unchanged. However, NICE believes the medication should be available to people at a lower risk of heart disease.
Prior to the new guidance, people with a 10% or higher risk over ten years of a heart disease or a cardiovascular event were recommended satins. After new research and evidence on the side effects and safety of statins, more people could receive the medication.
Statins can sometimes cause side effects such as muscle pains, however, evidence suggests that most people do not suffer these side effects. Research also shows that many more people will get muscle pains whether they take statins or not than have muscle pain caused by statins.
More statins will reduce cases of heart disease
The new guidelines recommend that statins are now considered as part of a shared decision-making process for people who have not suffered had a cardiovascular event (CVD) with a ten-year CVD risk score of less than 10%. The committee agreed that if more people were given the medication there would be a significant reduction in incidence of heart disease and stroke.
NICE recommend that doctors consider prescribing atorvastatin 20mg for the primary prevention of CVD for people with a ten-year risk of less than 10% if the patients is happy to take the statin. Statins should also be considered if there is concern that the patient’s risk of a cardiovascular event may have been underestimated.
CVD is the highest global cause of death, and high cholesterol is a significant risk factor. It causes a third of all ischaemic heart disease cases and is a contributing factor in many other conditions. High cholesterol leads to over 7% of all deaths in England and affects up to 60% of adults.
Statin use should be considered alongside lifestyle factors
Anyone can be at risk from CVD due to factors beyond their control, including age, sex, ethnicity and family history. The NICE guidance continues to recommend that risk factors which can be addressed should be managed closely. These include stopping smoking, reducing alcohol consumption, regular exercise and a healthy diet.
“What we’re saying is that, for people with a less than 10% risk over ten 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,” said Paul Chrisp, director of the Centre for Guidelines at NICE.
“The evidence is clear, in our view, that for people with a risk of 10% or less over ten years, statins are an appropriate choice to reduce that risk,” he added.
According to NICE estimates the new guidance will mean for every 1,000 people with a risk of 5% of heart disease over the next ten years who take a statin, about 20 people will not get heart disease or have a stroke because they take a statin. This figure increased to 40 for people with a risk of 10%, and for people with a risk of 20% NICE estimates that around 70 people would not get heart disease or have a stroke in the next ten years.
“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,” concluded Chrisp.
