New evidence on the safety of statins means more people could benefit from them, NICE says.  

Draft updated guidance from clinical watchdog published today (January 12) recommends that the risk threshold at which statins are offered to prevent cardiovascular events such as heart disease and strokes should remain unchanged, but they can now also be considered for people at a lower threshold. 

Up until now people with a 10 per cent or higher risk over 10 years of a cardiovascular event should be offered a statin under current NICE guidance. 

That is set to change after the independent committee considered new evidence on the side-effects and safety of statins, meaning a wider group of people could be given them. 

The draft guideline recommends statins can now be considered as part of shared decision-making for people who haven’t had a CVD event (called ‘primary prevention’) with a 10-year CVD risk score of less than 10 per cent. The committee agreed that if more people took statins there would be a greater reduction in CVD events. 

The draft guideline recommends that atorvastatin 20mg is considered for the primary prevention of CVD for people with a 10-year risk of less than 10 per cent.

NICE estimates that under this new recommendation, on average, for every 1,000 people with a risk of 5 per cent 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 per cent, and for people with a risk of 20 per cent NICE estimates that, on average, around 70 people would not get heart disease or have a stroke in the next 10 years. 

However, the committee agreed that focusing on increasing uptake among people with the highest risk of CVD 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 For this reason, the draft guidance says that, while people at lower risk can be considered for statin therapy, people at a higher risk should continue to be offered statins.

Appropriate choice

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