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The waiting game

Dr Terry McCormack: 'This will extend statin treatment to younger patients'

Dr Terry McCormack looks at the implications of NICE’s decision to reduce the risk threshold for primary prevention.

A 10% risk threshold for primary prevention is going to be very controversial. The Americans introduced the same idea very recently and there were a lot of skeptics.

It is low and it’s going to include a lot more people in treatment. The thing is, if you treat everybody then you miss nobody. But you end up treating a lot more people who are not going to benefit.

I personally think that, just looking at absolute risk is not necessarily the way to do things, but what’s better is to look at absolute risk and relative risk. For instance, if you had an absolute risk of 10%, but were healthy in every other respect, your relative risk might be as low as one.

It’s good, in that it allows you to treat pretty much everybody. But I’m certain that there will be a hue and cry from the lobby of people who are not keen on cholesterol testing in the first place.

The positive thing is that a 10% threshold is going to be more inclusive of younger people. At a certain age you’re almost guaranteed to be at 20% risk anyway; around 55 to 60 years most people are going to be at 20% risk just on their age alone.

More people in their 40s and 50s are going to be eligible, and these are the people I’m keen to treat. I’d much rather treat someone when in their 50’s when they’ve got years to go.

It will mean more people are going to have their blood pressure checked, and we’ll find more people with abnormal blood pressures. It’s very much the case that young people with high blood pressures need sorting out as well.

The main effect will be that a different age group will suddenly be included, and that will be a good thing.

Dr Terry McCormack is a GP in Whitby and secretary of the British Hypertension Society

Readers' comments (4)

  • But will it just result in people feeling 'protected' so that they just continue with bad diets, no exercise and continue to smoke?

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  • @Anonymous 12Feb. The same argument (that giving people more protection encourages them to take more risk) has been used to warn against many safety advances through the ages - compulsion to wear seatbelts and motor bike helmets, the use of cycle helmets, boat buoyancy etc. This may be the case in a very, very few extreme risk takers, but is certainly not something which affects the general population. On the contrary, it could be argued that recognition by the 'authorities' that a risk exists raises awareness and encourages more risk aversion. As Dr McCormack says in his article - this move by NICE will help GPs access more people to give lifestyle advice and opportunistic BP checks as well as assessing the need for medication. Either we believe prevention is better (and cheaper) than cure, or we don't.

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  • According to the Today programme snippet this morning, the research that has prompted NICE's decision was carried out on their behalf by pharma. I'm not clear whether the BHS view (above) is similarly sponsored by pharma. If so, then doesn't that colour their judgement? I would be happier if I knew that this new threshold is supported by independent reasearch by independent organisations.

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  • Ivan Benett

    NICE is independent and Statins are generic, so the conspiracists don't have a leg to stand on. Statins are just about the only thing we know of that improves you chances of longevity, and not smoking of course (although no RCTs). Even exercise, diet and weight control has not been unequivically proven.
    Instead of dismissing things in a red mist of cynicism, why not discuss it with the patient and see what they think? Just a thought

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