Fewer high-risk patients put on statins since NICE guidance, study finds
The proportion of high risk patients put onto statins declined after NICE guidelines cut the CVD threshold from 20% to 10% 10-year risk in 2014, a new study has revealed.
Researchers from the University of Birmingham also found that the numbers of intermediate risk patients being put on statins increased following the release of the controversial NICE guidance on lipid modification.
They concluded that there was a ’significant overtreatment’ in patients in the lower risk categories.
The NICE guidance was released in 2014, and lowered the risk threshold for patients to be put on statins.
However, the new study published in the British Journal of General Practice, revealed that they have had an effect on prescribing for those with an intermediate 10-year risk score of 10%-20%.
Researchers looked at data for 1.4 million patients over 40 from 248 practices in England and Wales recorded between 2000 and 2015. The team led by Dr Samuel Finnikin, the winner of Pulse’s writing competition this year, examined how prescribing trends related to the cardiovascular disease risk QRISK2 scoring.
In the 18 months before the guidelines changed, 12.8% of patients with an intermediate risk score were initiated on statins; in the 18 months after, 14.4% were initiated.
However, the proportion of high-risk patients put on statins decreased from 36.7% in the 18 months before the guidelines changed to 33.1% in the 18 months after.
The study concluded: ‘It appears that the 2014 NICE guidance changed clinicians’ behaviour as the rate of statin initiation among patients in the intermediate risk category increased while the high risk rate continued to decline.’
The researchers added: ’Most patients at high risk of CVD were not initiated on statins. One in six statin initiations were to low risk patients indicating a significant overtreatment. Initiations of statins in intermediate risk patients rose after NICE guidelines were updated in 2014.’
The row over NICE’s push for statins
Introduced in July 2014, NICE’s updated guidelines on lipid modification advocated halving the risk level at which outwardly healthy people should be considered for statin therapy – from a 10-year predicted risk of 20% to 10%.
At the time, NICE estimated this would make around five million more people eligible to start taking a statin – with the potential to ‘save 8,000 lives over three years’ and prevent ‘up to 28,000 heart attacks and 16,000 strokes each year’.
However, the move was roundly condemned by GP leaders, with both the GPC and RCGP questioning the evidence behind it and warning it would not only risk overmedicalising vast swathes of the population, but also swamp already overburdened practices with extra appointments, diverting precious time away from patients in more immediate need.