Millions more Brits to get statins under health chiefs’ recommendations

GPs will prescribe lifesaving statins to anyone who wants them under new guidance aimed at preventing thousands of heart attacks and strokes.

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

It means millions more adults aged 18 and over can now request statins on the NHS.

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

But they will 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) has updated its guidelines after its committee considered new evidence.

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

The 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 yesterday said the ‘evidence is clear’ that statins are an ‘appropriate choice’ for people who want to reduce their risk of disease.

Sir Chris Whitty, the UK’s chief medical officer, recently warned that thousands of middle-aged people are dying of heart conditions because they did not get statins or blood pressure medicines during the pandemic.

The new 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.

About eight million people in the UK already take the pills but Nice estimates there are 15million people in England aged between 25 and 84 with a risk score below the current threshold.

It recommends that people are assessed for their risk of developing cardiovascular disease by accounting for factors such as whether or not they smoke, their cholesterol levels, blood pressure, and body mass index.

GPs 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 , such as their age, sex, ethnicity and family history.

However, the draft guidance continues to recommend that risk factors which can be addressed should be managed.

These include stopping smoking, reducing alcohol consumption, taking exercise 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 their calculated 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. 

Statins are the most widely prescribed drugs in the world, with around 8million Britons and 32million Americans taking them every day to cut their risk of heart complications due to high blood pressure

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 10 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.

‘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 18 million deaths each year – over 30 per cent of all global deaths.

High cholesterol is a significant modifiable risk factor for CVD. 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 £100 million.

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

Professor Sir Nilesh Samani, medical director at British Heart Foundation, described the new Nice guidance as ‘good news’ as it will help to reduce the number of heart attacks and strokes.

He added: ‘Heart attacks and strokes still kill more people prematurely than anything else, with high levels of cholesterol being a major risk factor.

‘Research has shown that statins are largely safe.

‘However, the decision to start this medication, which needs to be taken on a on a long-term basis, is very much a personal choice.

‘The decision should be based on a conversation with your GP, and should be combined with other measures such as eating a healthy diet and exercising regularly to get the most benefit.’

Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: ‘There is a good research base that shows statins are safe and effective at reducing the risk of cardiovascular conditions, such as stroke and heart attacks, when prescribed appropriately.

‘GPs are highly trained to prescribe statins within clinical guidelines and in conversation with patients – long term statin therapy, however, won’t be suitable or desirable for everyone, and a decision to prescribe them will never be taken lightly.

‘On a daily basis, GPs and their staff teams are encouraging people to improve their health and reduce their cardiovascular risk through changes to their diet, not smoking, and taking plenty of exercise.

‘It is imperative that we do not over-treat and over-medicalise people, and that clinicians look beyond a risk calculator to measure someone’s risk– considering all the various factors potentially impacting on a patient’s health.

‘The College looks forward to examining the draft Nice guidelines and the evidence behind them and contributing the views of our members during the consultation stage.’

The draft guidelines are now open to public consultation until February 2.

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