A recent clinical practice guideline by NICE, the National Institute for Health and Care Excellence, has been published recommending that doctors should halve the threshold for starting preventative treatment of cardiovascular disease (CVD) from a 20% risk of developing these conditions over 10 years to a 10% risk following research by Oxford University.
NICE have reported that although death rates from CVD have halved since the 1970s, it is still the leading cause of death in England and Wales. In 2010, 1 in 3 people died from CVD.
CVD develops when fatty acid deposits, known as atheroma, build up in arteries and narrow them, leading to coronary heart disease and stroke. The risk of developing CVD is increased by lifestyle factors such as a high cholesterol diet and smoking. NICE recommends that people are assessed for their risk of developing cardiovascular disease using measurements of whether or not they smoke, their cholesterol levels, blood pressure and body mass index in order to calculate a percentage risk of developing CVD in the next 10 years.
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said “The risk is measurable and we can substantially reduce someone’s chance of a heart attack, angina, stoke and the other symptoms of cardiovascular disease by tackling the risk factors. We also recommend that statins are now offered to many more people- the effectiveness of these medicines is now well proven and their cost has fallen.”
However, this guidance is by no means final. It is currently issued as a draft for public consultation until 26 March 2014. Baker has said “We now want to hear views on this draft guidance which recommends that people with a 10% risk of developing CVD within 10 years are offered statins.”
This decision comes after a 2012 Oxford University study published in the Lancet, which showed that even very low-risk patients benefited from statins with almost no side effects. Currently, 7 million people in the UK take statins, at an estimated annual cost of £285 million. Professor Rory Collins, from the Oxford University team, said that the number of people who would begin taking statins as a result “would be in the order” of five million.
Professor Collins maintained that taking statins “remains a choice for the patient, it’s not mandatory.”
Professor Colin Baigent, another member of the Oxford University team, calculated that five million more people taking statins “would save 2,000 lives and prevent 10,000 heart attacks or strokes every year.”
Of course, statins are most effective in conjunction with lifestyle changes.. Professor Baker said, “as well as taking statins, people with raised cholesterol levels and high blood pressure should reduce the amount of foods containing saturated fat they eat.”
Marco Narajos, first year medical student and Online Editor of Bang! Science Magazine, said, “I think it’s a good idea, especially if the risk of side effects are low. However, even if the probability is low, some people could still be affected by the few side effects such as headaches and insomnia, especially if a large number of people take the drug. Whatever decision is made, every effort should still be made to ensure that people exercise more often and eat a healthy diet low in saturated fats, salt, and sugar, especially from a young age. The old proverb ‘An ounce of prevention is worth a pound of cure’ definitely holds true, even today.”
