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Cardiovascular disease

NICE guidance could see 12 million adults prescribed statins in England, researchers say

New research is based on a scrutiny of a risk algorithm in the guideline which calculates an individual’s chances of developing cardiovascular disease in the next ten years.

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Prescribing statin treatment for everyone over the risk threshold would add to GPs’ workload

Almost 12 million adults in England would be recommended statins if National Institute for Health and Care Excellence (NICE) guidance on cardiovascular disease (CVD) risk and lipid-lowering treatment was applied to the population, researchers have calculated.

Writing in the British Journal of General Practice the researchers found that if the guidance was accurately followed 11.8 million adults would show a 10% increased risk of developing CVD in the next 10 years and would therefore be recommended statins.

The researchers, led by a professor of global health at Harvard University, wrote: “Under the new [2014] guidelines, 95% of males and two-thirds of females without existing CVD in ages 60–74 years, and all males and females in ages 75–84 years, would require statin therapy.”

Their research was based on a scrutiny of the QRISK2 algorithm in the guideline which, according to 15 risk factors, calculates an individual’s chances of developing CVD in the next 10 years.

They used the algorithm to discover the 10-year risk of 2,972 adults who had participated in the Health Survey for England 2011 and had provided a blood sample.

Using their findings they went on to calculate a population estimate of adults in England who would be eligible for primary prevention statin treatment under the NICE guideline.

They point out that the algorithm gives a “large weight” to age as a predictor of CVD risk.

“Even with optimal risk factor levels, males of different ethnicities would exceed the 10% risk threshold between the ages of 60 and 70 years, and females would exceed the threshold between 65 and 75 years,” they say.

They estimate that if the number of adults identified as eligible for statin treatment were diagnosed it would mean every GP in England would each have to manage an extra 200 patients on statins.

They say: “Implementation of the NICE guidelines should be considered in the context of opportunity costs for primary care and its available resources, in particular given the high and increasing workload facing GPs in England.”

NICE recommendations

The 2014 NICE guideline recommends that the QRISK2 algorithm be used to determine CVD risk. It recommends that statins be prescribed for primary prevention in cases where risk is calculated at more than 10%.

The 2014 guideline replaced an earlier 2008 version. That guideline recommended statins as primary prevention only when the CVD risk was higher than 20%; no specific algorithm was endorsed.

Commenting on the findings, professor Helen Stokes-Lampard, chair of the Royal College of GPs, said GPs needed to get the risk scores right: “If we find that all men over 60 and all women over 75 are going to be eligible for statins with new risk scoring, regardless of any other risk factor, then it should ring alarm bells — because it is not clear that every 60-year-old man or 75-year-old woman is going to benefit from statin therapy.

She said clinical guidelines are “useful tools for GPs” but they are “not tramlines”.

In a statement on its website NICE said that the 2014 guidance is based on the “overwhelming body of evidence supporting the use of statins, even in people at relatively low risk”.

It said that the guideline “does not impose statins on everyone with a 10% or greater risk of developing heart disease or having a stroke within 10 years”.

The guideline “recognises the importance of personal choice in determining what measures are appropriate for preventing these”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203340

Readers' comments (1)

  • I find this really disturbing news and think there needs to be more research before guidelines are changed on the strength of one article.
    Many people do not like taking statins, they can affect people adversely psychologically and physically. For people who took statins for 5 years without known heart disease the NNT to prevent one stroke was 268, to prevent one non-fatal heart attack was 60 , the NNH to cause harm (diabetes) was 50 and to be harmed by muscle damage was 10.
    If people had heart disease and took a statin for 5 years; NNT to prevent fatal heart attack was 83, 39 to prevent one non-fatal heart attack and 125 to prevent one stroke.
    In terms NNH the NNH to cause harm (diabetes) was 50 and to be harmed by muscle damage was 10. (David Newman, 2013)1

    People need to be informed about the considerable risks of statins to be able to make informed choices.

    Denise Taylor

    1. http://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease/

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