More people could be offered statins under new NICE guidance

The National Institute for Care Excellence (NICE) has updated its guidance to widen the pool of people that should be considered for statin therapy.

Until now, statins were only recommended for people with a 10% or higher risk over 10 years of a cardiovascular event. However, under the new guidance, NICE says statins should now be considered for people who haven’t yet had a CVD event with a 10-year CVD risk score of less than 10%.

A shared decision-making process

The change in guidance comes after new evidence revealed that the risk of serious side effects from statins is low, and that the incidence of heart attack and stroke could be lowered if more people took statins.

However, NICE are clear that statins should only be prescribed once other avenues have been explored, for example, ensuring the patient is eating a healthy, balanced diet and exercising regularly.

NICE also emphasise that doctors should discuss the benefits and risks of statins with the patient and come to a joint decision about whether to prescribe the medication.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “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.”

What are the side effects of statins?

Statins are a type of medication used to lower low-density lipoprotein cholesterol (also known as ‘bad’ cholesterol) in the blood.

High levels of LDL cholesterol can lead to a hardening and narrowing of the arteries and CVD. Statins can therefore help to lower the risk of a CVD event.

However, statins can sometime cause side effects, particularly if they interact with other medications. Most people who take statins experience no or very few, minor side effects, such as: muscle pain, headaches, dizziness and nausea.

Muscle pain is one of the most commonly reported side effects, but NICE says that 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.

Preventing cardiovascular disease

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.

While the benefit of statin use is therefore clearer for people at higher risk of CVD, NICE say that there is still a “clear” benefit that statins are an “appropriate choice” for people at lower risk of CVD.