The Pharmaceutical Journal
Vol 276 No 7385 p95
28 January 2006

This article
Reprint   Photocopy

  Acrobat Reader

News summary

NICE lowers threshold for initiation of statin therapy to prevent CVD

Statin therapy for the primary prevention of cardiovascular disease(CVD) has been recommended by the National Institute for Health and Clinical Excellence for adults who have a 20 per cent or greater 10-year risk of developing CVD. Guidance published this week also recommends statins for adults with clinical evidence of CVD.

The treatment threshold endorsed by NICE concurs with that in the recent Joint British Guidelines on Coronary Prevention in Clinical Practice (PJ, 24/31 December 2005, p767). A higher threshold was specified in the National Service Framework for Coronary Heart Disease (30 per cent 10-year risk of CHD equivalent to a 40 per cent 10-year risk of CVD), published in 2001.

NICE estimates that around 3.3 million people will become eligible for therapy as a result of its recommendations. It adds that therapy should be part of a management strategy that includes lifestyle measures.

In deciding which statin to prescribe, NICE advises that therapy should be started with a drug with a low acquisition cost, taking into account price per dose and the dose required. NICE is developing a clinical guideline on cardiovascular risk assessment, which is expected to be published in September 2007. This guideline will evaluate specific risk factor algorithms and consider the use of cholesterol target levels.

Commenting on the guidance, Helen Williams, pharmacy team leader for cardiac services at King’s College Hospital, London, said: “In clinical practice, there has been a gradual move towards the wider use of statins for the prevention of cardiovascular events, in line with the growing evidence base.

“This NICE guidance will ensure a consistent approach to statin use across both primary and secondary care. Lowering the threshold for intervention will allow clinicians to address CV risk early, in a group of patients not previously treated comprehensively.”

Paul Hurrell, managing director of McNeil Ltd, manufacturer of the over-the-counter presentation of simvastatin, commented that OTC statins are targeted at the risk level immediately below that specified in the NICE guidance. “What the new guidance does is effectively ‘close the gap’ that existed previously and should allow for seamless care ranging from self-care with OTC statins for those at moderate risk through to prescription statins for those at higher risk.”