Millions more Brits to get statins under health chiefs’ recommendations

Millions more people will be able to get statins on the NHS under radical guidelines aimed at preventing thousands of heart attacks and strokes.

The drugs watchdog has widened the eligibility criteria for the cholesterol-busting pills after a major review found they are safe and rarely cause side effects.

Up to now, GPs were told to offer statins to patients with a 10 per cent or higher risk of suffering a heart attack or stroke within a decade.

But they will now be able to prescribe the 2p-a-day tablets to anyone who asks for them, even if they have a much lower risk of cardiovascular disease.

The National Institute for Health and Care Excellence (Nice) is updating its guidelines on cardiovascular disease risk assessment and reduction after its committee considered new evidence.

It estimates there are around 15million people in England aged between 25 and 84 with a risk score below 10 per cent.

The update comes after a landmark study last year revealed statins have been wrongly blamed for muscle pains that are really a symptom of old age.

University of Oxford researchers showed ‘definitively’ that warnings about the potential side-effect are unfounded and people’s complaints are largely ordinary niggles, which are often the result of ageing or being too active.

The ‘gold standard’ study, published in the Lancet, involved 155,000 patients and found an almost identical risk of muscle pain in people not taking statins.

Nice said today: ‘Although statins can sometimes cause side effects such as muscle pains, the best evidence shows that most people don’t get muscle pains with statins, and many more people will get muscle pains whether they take statins or not than have muscle pain caused by statins.’

The guideline recommends statins can now be considered as part of ‘shared decision-making’ between a doctor and patient for people who have not had a heart attack or stroke and have a risk score of less than 10 per cent.

Nice recommends that people are assessed for their risk of developing cardiovascular disease using measurements including whether or not they smoke, their cholesterol levels, blood pressure, and body mass index.

Doctors enter this detail into an online calculator that provides a percentage risk of developing cardiovascular disease in the next ten years.

People can be at risk from cardiovascular disease because of factors they cannot change including their age, sex, ethnicity and family history.

The draft guidance continues to recommend that risk factors which can be addressed should be managed.

These include stopping smoking, reducing alcohol consumption, exercising and eating a healthy diet.

Doctors are advised to consider 20mg of atorvastatin where there is patient preference for taking a statin or concern that risk may be underestimated.

Nice estimates that under this new recommendation, for every 1,000 people with a risk of 5 per cent 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 doubles to 40 for people with a risk of 10 per cent, and for people with a risk of 20 per cent around 70 people would not get heart disease or have a stroke in the next ten years.

However, the committee agreed that focusing on increasing uptake among people with the highest risk of cardiovascular disease events would have more impact.

For this reason, the draft guidance says that, while people at lower risk can be considered for statin therapy, people at a higher risk should continue to be offered statins.

Nice uses ‘consider’ recommendations when there is a closer balance between benefits and harms of an intervention that could be used.

Paul Chrisp, director of the Centre for Guidelines at Nice, said: ‘What we’re saying is that, for people with a less than 10 per cent 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.

‘The evidence is clear, in our view, that for people with a risk of 10 per cent or less over ten 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.

‘And it may well be that many people will say that they are happy to accept a risk of having a heart attack or stroke rather than taking statins every day — which is absolutely their prerogative.

‘They just need to know and understand the level of risk — and this in itself can be a complex discussion.’

He added: ‘Put simply, it is the responsibility of GPs to explain the ways in which people can reduce their risk of cardiovascular disease, presenting all the options promoted by the draft guidance, including lifestyle changes, blood pressure control, avoidance of diabetes and cholesterol lowering, and allow patients to make their own decisions.

‘Finally, it should be stressed that people who want to talk to their GP team about this should do so at their next routine appointment, they don’t need to take urgent action.’

Cardiovascular disease is the leading cause of death worldwide, accounting for almost 18million deaths each year — over 30 per cent of all global deaths.

High cholesterol is a significant modifiable risk factor for cardiovascular disease. It causes a third of all ischaemic heart disease, and contributes in many other cases.

In England, high cholesterol leads to over 7 per cent of all deaths, causes just under 4 per cent of disability-adjusted life-years, and affects up to 60 per cent of adults.

Over 70 million prescriptions for statins are dispensed in England each year, costing the NHS around £100million.

The total healthcare cost of cardiovascular disease in England is estimated to be £7.4billion.

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