Millions more people could be given choice to take statins

Statins: How the drug prevents heart attacks and strokes

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Under current guidelines, statins are routinely prescribed to anyone with a 10 percent or higher risk of suffering a cardiovascular event. After a recent assessment, however, the National Institute for Health and Care Excellence (NICE) has decided more people will be able to decide whether the clot-busting drug is suitable for them. The draft guidelines could slash the risk of cardiovascular events in the general population by a significant amount, experts predict.

The decision to change the threshold comes after NICE was presented with new evidence on the side effects and safety profile of the drug.

What’s more, only people with a 10 percent or higher risk of cardiovascular events are eligible for treatment with statins, despite 15 million Britons aged 25 to 84 having a 10-year-risk up to 10 percent.

The draft guidelines recommend that statins be considered as part of shared decision-making for people who haven’t had a cardiovascular event.

For patients with a 10-year risk below 10 percent, doctors will be urged to consider prescribing 10mg of atorvastatin, provided that there is a patient preference for taking statin or concern that the risk may be underestimated.

Doctors will also be advised to check that there is some risk of cardiovascular events, however small, before issuing a prescription.

Individuals considering statin treatment can have their risk of heart disease, heart attack and stroke assessed during routine appointments with their GP.

Doctors assess a cardiovascular risk over the next 10 years using a QRISK3 calculator.

The calculator uses data routinely collected from general practices across the country to calculate the risk of cardiovascular events like stroke and heart attack.

More specifically, it takes into account whether a person smokes, their cholesterol levels, blood pressure and body mass index (BMI).

This means that millions more people deemed at risk of a heart attack or stroke could be able to choose whether to take statins.

The NICE committee made this agreement on the ground that if more people take statins, the reduction in heart disease and stroke incidences would be greater.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “What we’re saying is that, for people with a less than 10 percent risk over 10 years of a first attack or stroke, the decision to take a statin should be left to individual patients after an informed discussion of benefits and risks.”

He continued: “We are not advocating that statins are used alone.”

Doctors will continue to encourage a healthier lifestyle for patients with a cardiovascular risk below 10 percent before prescribing statins.

However, if all these measures have been adopted and treatment with statins still feels necessary, a pill can be prescribed.

Mr Chrisp added: “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.

“They don’t have to, and their decision should be informed by an understanding of the risks and tailored to their values and properties.

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

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

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