NICE backs lower-risk threshold for statin treatment

People with a 10 percent or greater chance of developing cardiovascular disease (CVD) in 10 years should be treated with high-intensity statins, the U.K.’s National Institute for Health and Care Excellence (NICE) recommended in draft guidelines published Feb. 12. This is a change from the previous guideline that recommended treatment for people with a 20 percent or greater risk.

The Guidelines Development Group (GDG) identified seven priority implementations based on available evidence. In addition to starting statin treatment at a lower risk level, the group recommended a systematic strategy to identify people between the ages of 40 to 74 most likely to be at risk for CVD.

They also recommended the use of the QRISK2 to predict the risk of cardiovascular disease. QRISK2 is an assessment tool that considers risk factors such as age, blood pressure and total cholesterol to determine CVD risk. The group previously recommended the Framingham risk tool, which is used in the U.S. QRISK2 is more accurate, according to the GDG.

Clinicians should also regularly record ethnicity, body mass index and family history of early CVD in patients’ medical records.

They should measure at least one full lipid profile, which includes total cholesterol, high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol and triglyceride levels. There is no need for a fasting sample.

Primary prevention of CVD should be accomplished with 20 mg of atorvastatin (Lipitor, Pfizer). For patients with established CVD, treatment should be 80 mg of atorvastatin. However, lower doses should be used in cases of potential drug interactions, risk of adverse effects and if there is a patient preference.

The draft guidance is available for public comments until March 26.