The National Institute for Health and Care Excellence (NICE) has released a draft guidance on the management of high cholesterol for people with and without cardiovascular disease, as well as those with diabetes and chronic kidney disease.
NICE, an agency that provides guidance for the United Kingdom’s National Health Service, recommends that high-intensity statin medications be given as a primary preventative treatment in patients with a 10 percent risk of cardiovascular disease over the next 10 years. Previously, the recommendation was for patients with a 20 percent risk of cardiovascular events over the next 10 years be treated with statins. Furthermore, NICE suggested physicians use a QRISK2 calculator to assess risk in people ages 40 to 74 who are at high risk for cardiovascular disease.
The guidelines recommend that 20 mg of atorvastatin, known by the brand name Lipitor, be started as a primary prevention for patients, whereas previous recommendations were to start treatment at 40 mg of simvastatin, also known as Zocor. In secondary prevention, it was recommended that 80 mg of atorvastatin be used in patients with established cardiovascular disease. Lower doses could be used in patients who experience adverse effects or have drug interactions but “treatment should not be delayed” the guidelines state.
In November, the American College of Cardiology and the American Heart Association released new guidelines for the management of cholesterol. The guidelines do not outline specific LDL targets and instead focus on the intensity of statins for reducing cholesterol levels in primary and secondary prevention. The recommendation would greatly increase the number of people taking statin medications.
The proposed American guidelines were met with some criticism. Statin therapy can be difficult for some patients to tolerate with side effects ranging from muscle aches to muscle injury and liver damage. The drugs can also increase blood sugar levels and put users – especially postmenopausal women – at risk for type 2 diabetes.