UK's NICE Recommends Statins in High Risk Individuals

The United Kingdom's National Institute for Health and Clinical Evidence (NICE), the agency that (among other things) determines which medical products and services will be covered under the UK's National Health Service, has just released new Guidelines for Lipid Modification.

These new guidelines are particularly remarkable because they recommend that people between the ages of 40 and 75, whose 10-year risk of serious cardiovascular problems is greater than 20%, should begin taking statins.

Assessing your 10-year risk is straightforward. NICE recommends using the Framingham scoring system, which estimates the 10-year risk by asking a few simple questions. You can score your own Framingham 10-year risk here.

Specifically, the NICE guidelines recommend that individuals whose 10-year risk is greater than 20% should take generic simvastatin, 40 mg per day.

DrRich Comments:

Anyone who has been following the tribulations of the National Health Service knows that NICE is more famous for withholding cutting edge therapies than for taking the lead on new therapeutic recommendations. So for NICE to make a recommendation like this, that is, to urge individuals who are at high risk for cardiac disease to begin taking statins, independent of their lipid levels, is quite remarkable.

Statins are most famous for reducing LDL cholesterol levels, but it happens that these drugs appear to have other actions that can reduce risk, such as stabilizing plaques, reducing inflammation, and improving vascular function. How significant these non-lipid effects of statins may be is still being worked out, and therefore today statins still are almost always prescribed for lipid lowering, and not for overall risk reduction.

For NICE to recommend statins to prevent cardiac events in patients who have not already manifested heart disease can mean only one thing. It means that buying statins for such patients will save the UK's National Health Service substantial amounts of money. Indeed, NICE has estimated that this new recommendation may prevent up to 15,000 (very expensive) heart attacks a year.

People living outside the UK who have an increased Framingham score might want to discuss this new recommendation with their own doctors.