The National Institute for Health and Care Excellence says that doctors should consider many more people to be at risk of cardiovascular disease, and that the threshold for starting preventive treatment should be halved from a 20% risk of developing CVD over 10 years to a 10% risk.

Prevention includes stopping smoking, reducing alcohol consumption, taking exercise and eating a healthy diet, and once these factors have been addressed, high-intensity statin therapy should be offered, says NICE, in final updated guidance which in draft form has already proved highly controversial.

“Doctors have been giving statins to ‘well people’ since NICE first produced guidance on this in 2006. We are now recommending that the threshold is reduced further,” said Mark Baker, director of the centre for clinical practice at NICE.

The “overwhelming body of evidence” supports the use of statins, even in people at low risk of CVD. The effectiveness of the medicines is now well-proven and their cost has fallen, he added.

“The weight of evidence clearly shows statins are safe and clinically and cost-effective for use in people with a 10% risk of CVD over 10 years. We’re not saying that everyone with a 10% or greater risk of CVD within 10 years needs to take a statin – the guideline recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between benefits and risks,” said Prof Baker.

CVD causes one in three deaths in the UK, or 180,000 each year, from strokes, coronary heart disease and peripheral arterial disease. By recommending a systematic approach to identifying people at risk, the guideline will enable people to access treatments to address that risk by reducing their cholesterol levels, and also provide further clarity for practitioners in primary and secondary care about how to manage patients both with and without pre-existing CVD says NICE.

“One of the key challenges is how to convince people who feel well that they need to make substantial lifestyle changes or that they benefit from lifelong drug treatment. This requires high-quality information and communication on the benefits and risks of these therapies and this is reflected in the guideline,” said Liz Clark, a lay member of NICE’s guideline development group.

‘The guideline therefore places patients centrally in any decision-making about their management and it emphasises the need to address all CVD risk factors in combination. It also recommends that people are involved in developing a shared management plan,” she said.

You can read more on the statin debate in the July/Aug issue of PharmaTimes Magazine here.