Millions more British patients could be prescribed statins to guard against strokes and heart attacks in light of research that has prompted a radical change in American guidance.
The findings led to a recommendation in the US that anyone with a 7.5 per cent chance of a heart attack over 10 years should be considered for the drugs.
Guidance in England and Wales is that only those with a 20 per cent risk should be given statins.
Tonight the National Institute for Health and Care Excellence (Nice) confirmed that its experts would consider the same evidence that brought about the American shift in policy. Nice is to publish new guidelines next year.
Should it adopt a similar position and lower the threshold, millions more people would be eligible to be prescribed the drugs.
Statins, which cost the NHS less than 10p per patient per day, are the most commonly prescribed drugs in Britain, used by an estimated six million.
Doctors used to prescribe them only to patients with a 30 per cent risk of a heart attack in the next 10 years, but this was lowered to 20 per cent in 2005.
Tonight experts predicted a further widening of eligibility following the new evidence.
Dr David Wald, a cardiologist at Queen Mary, University of London, said it is “sensible” to lower the threshold on eligibility, which is “heading towards the point where statins may eventually be offered to everyone once they reach 50 to 55 years of age”
“For some years many have taken the view that the current risk threshold of 20 per cent over 10 years is too high a bar for treatment,” he added.
Helen Williams, a consultant pharmacist for cardiovascular disease and a member of the Royal Pharmaceutical Society, said: “I am not sure we will go all the way down to 7.5 per cent, but I was thinking 10 to 15 per cent myself.”
She added that new British guidelines could be based on a patient’s lifetime risk of heart attack or stroke, rather than 10-year risk. Statins work by lowering levels of “bad” LDL cholesterol produced by the body, which builds up fatty deposits in the arteries and raises the risk of coronary heart disease and stroke.
The drugs have been shown to reduce inflammation within blood vessels and the risk of stroke-inducing blood clots. A major review of 16 studies earlier this year suggested that they could also offer some protection against dementia.
Many doctors have long argued that statins should be more widely prescribed, with some studies recommending they be issued to everyone over the age of 50.
Others have warned of the dangers of prescribing the drugs to healthy people, because of the risk of side effects including serious kidney problems.
The new US guidelines, announced on Tuesday, followed a four-year review of evidence by the American College of Cardiology and the American Heart Association. Under the guidance, an estimated 44 per cent of men and 22 per cent of women would meet the threshold for statins – 33?million Americans.
The previous US guidelines recommended the drugs for about 15 per cent of adults, requiring patients to lower cholesterol to a target figure, but these numerical goals have now been abandoned.
Statins
Instead a formula taking into account other factors including age, gender and race is used to determine which patients may benefit. The review also recommended that statins should be taken by patients with heart disease, people aged between 40 and 75 with type 2 diabetes and those with a “bad” cholesterol rating of 190 or higher on the US scale, equivalent to about 4.9 on the scale used in Britain.
NHS guidelines recommend that LDL cholesterol should be no higher than 3.0 and overall cholesterol no higher than 5.0.
Overall the review’s recommendations could double the number of Americans taking statins, the authors said. Professor Neil Stone of Northwestern University, the chairman of the expert panel behind the new guidelines, said: “The likely impact of the recommendations is that more people who would benefit from statins are going to be on them.”
“We’ve been undertreating people who need statin therapy,” said Dr Donald Lloyd-Jones, one of the experts who wrote the new guidelines. “Statins lower cholesterol levels, but what they really target is overall cardiovascular risk.”
British guidelines already included factors such as age and gender, but a reduction in the ten-year risk threshold for heart attack and stroke is possible in light of the evidence which prompted the US policy shift.
Nice has frequently cited the findings of US experts, including the American College of Cardiology and American Heart Association, in reviewing products and procedures for NHS patients.
A Nice spokesman said that its forthcoming guidance “follows a review of new and emerging evidence that was felt likely to affect the original recommendations in a number of clinical areas, including the use of statins both to lower the risk of developing cardiovascular disease (CVD) and in secondary prevention in people with established CVD.”
However, others suggested that Nice could also choose to follow separate guidelines being drawn up by the Joint British Societies, including the British Heart Foundation (BHF) and the British Cardiovascular Society, which are due to be published later this year.
This advice could recommend a move towards assessing a patient’s risk of suffering a heart attack or stroke at any point in their life, rather than over the next ten years, to allow earlier treatment.