In new draft guidance, the National Institute for Health and Care Excellence (NICE) is recommending that people with a 10% risk of developing cardiovascular disease (CVD) within 10 years should be offered statin therapy.
Currently, the threshold for starting preventive treatment for CVD is a 20% risk of getting heart disease, stroke or peripheral arterial disease over 10 years, but NICE is proposing to halve this, in a planned update of its existing 2008 guidance.
This advice is being updated in part to allow consideration of new evidence on CVD risk assessment tools and to reflect changes in the price and availability of generic statins, it says. At present, as many as seven million people in the UK are currently believed to be taking statins, at an estimated annual cost of £450 million.
Death rates from CVD have halved since the 1970s and 1980s, but it remains the leading cause of death in England and Wales; in 2010 the conditions accounted for 180,000, or one in three of all deaths. And long-term ill-health caused by CVD is increasing, says NICE.
The draft guidance recommends that risk factors for CVD which can be addressed – such as stopping smoking, reducing alcohol consumption, taking exercise and eating a healthy diet – should be managed. Once these factors have been addressed, high-intensity statin therapy should be offered, it says.
“Smoking, high blood pressure and raised cholesterol levels are big causes of CVD, especially in people with more than one of the factors, but the risk is measurable and we can substantially reduce someone’s chance of a heart attack, angina, stroke and the other symptoms of CVD by tackling the risk factors,” says Professor Mark Baker, director of the centre for clinical practice at NICE.
People should be encouraged to address lifestyle factors but NICE is also recommending that statins be offered to many more people. “The effectiveness of these medicines is now well proven and their cost has fallen,” Prof Baker adds.
The guidance also highlights that standard CVD risk scores will underestimate risk in people receiving certain treatments or have an underlying condition, including those: - treated for HIV; - with serious mental health problems; - taking medicines that can cause dyslipidaemia such as antipsychotic medication, corticosteroids or immunosuppressants; - with stage 1 or 2 chronic kidney disease; and - with autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis.
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