New NICE Guidelines Recommend Lower Risk Threshold for Starting Statins

July 18, 2014

LONDON, UK – The National Institute for Health and Care Excellence (NICE), the agency that provides guidance to the National Health Services (NHS), has published its new recommendations for the treatment of patients at risk for cardiovascular disease[1].

The new guidelines are an update to the 2006 clinical recommendations and push for a more aggressive approach to patient management, a change that was noted when NICE released its draft document in February 2013. As reported by heartwire at that time, the new NICE clinical guidelines recommend that physicians initiate treatment with atorvastatin 20 mg in patients with a 10-year risk of cardiovascular disease that exceeds 10%. Treatment should be started after patients have made an effort to lower their LDL-cholesterol levels with diet and lifestyle changes.

To estimate the 10-year risk of cardiovascular disease in individuals aged 40 to 74 years old, physicians are asked to use the QRISK2 risk-assessment calculator. For those with type 2 diabetes, the 10-year risk of cardiovascular disease is calculated using the United Kingdom Prospective Diabetes Study (UKPDS) tool.

Previously, the NICE guidelines recommended that patients with a 20% risk of cardiovascular disease over the next 10 years be treated with a statin. In the 2006 guidelines for lipid modification, simvastatin 40 mg was the drug of choice.

For those with existing cardiovascular disease or type 2 diabetes, the guidelines recommend starting treatment with atorvastatin 80 mg, a high-intensity statin aimed to achieve a reduction in LDL of at least 40%. A lower dose of atorvastatin can be used if there is the risk of drug interactions or adverse effects or even if the patient prefers to start with a less intensive statin.

The chair of the writing committee responsible for the new guidelines is Dr Anthony Wierzbicki (St Thomas' Hospital, London, UK).


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