NICE lowers threshold for statins to prevent cardiovascular events


The UK’s National Institute for Health and Care Excellence (NICE) has published draft guidance recommending that the risk threshold at which statins should be offered to prevent cardiovascular events such as heart disease and strokes remains unchanged, but they should also be considered for people at a lower threshold.

To date, people with a 10% or higher risk over 10 years of a cardiovascular event should be offered a statin under current NICE guidance.

But, after an independent committee updating the guideline on cardiovascular disease  risk assessment and reduction considered new evidence on the side effects and safety of statins, more people could be given them.

The draft guideline recommends statins can now be considered as part of shared decision-making for people who haven’t had a cardiovascular disease event with a 10-year risk score of less than 10%. The committee agreed that if more people took statins there would be a greater reduction in the incidence of heart disease and strokes.

The draft guideline recommends that doctors consider atorvastatin 20mg for the primary prevention of cardiovascular disease for people with a 10-year risk of less than 10% where the person is happy to take a statin or there is concern that the person’s risk of a cardiovascular event may be underestimated.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “What we are saying is that, for people with a less than 10% risk over 10 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.

“The evidence is clear, in our view, that for people with a risk of 10% or less over 10 years, statins are an appropriate choice to reduce that risk.

“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.”

NICE estimates that under this new recommendation, on average, for every 1,000 people with a risk of 5% over the next 10 years who take a statin, about 20 people will not get heart disease or have a stroke because they take a statin. This figure doubles to 40 for people with a risk of 10%, and for people with a risk of 20% NICE estimates that, on average, around 70 people would not get heart disease or have a stroke in the next 10 years.


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