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GPs 'should prescribe statins to all over 50s'

Public health experts have called for GPs to offer statins to all patients over the age of 50, after a major UK study published today suggested even those at low risk would benefit from treatment.

The call comes after an analysis of 22 trials in the Lancet showed statin treatment significantly reduced the risk of major cardiovascular events and death, even in groups with an estimated five-year risk of less than 5%.

The UK and Australian researchers suggested their findings showed the current threshold for prescribing statins for primary prevention of CVD should be lowered.

NICE confirmed that it would be looking at the research in its ongoing review of its guidance, that currently recommends a threshold of 20% or greater CVD risk over 10-years.

Any lowering of the threshold could have huge implications for GP workload as most people aged over 50 years have greater than a 10% risk of cardiovascular disease.

The analysis looked at the risk reduction for statins, compared with controls, for participants with different levels of CVD risk.

They found statin use was associated with a 38% reduction in risk of major vascular events in patients with a five-year risk of less than 5%, and a 31% reduction in those with a risk of 5% to 10%, compared with controls.

This translated to a an absolute reduction in risk of major vascular events of about 11 per 1,000 patients over five years, in those with a CVD risk of less than 10%.

The authors concluded that this benefit ‘greatly exceeds' any known hazards from statin therapy and suggested that NICE should reconsider their current guidance.

The study showed no evidence of increased cancer incidence or mortality.

The authors said: ‘The present report shows that statins are indeed both effective and safe for people with a five-year risk of major vascular events lower than 10% and, therefore, suggests that these guidelines might need to be reconsidered.'

In a related editorial, public health experts said the findings were ‘encouraging' and would ‘fit neatly' into NICE guidelines.

Professor Shah Ebrahim, professor of public health at the London School of Hygiene and Tropical Medicine, and Dr Juan Casas, senior research associate in epidemiology at University College London, said: ‘Because most people older than 50 years are likely to be at greater than 10% 10-year risk of CVD, it would be more pragmatic to use age as the only indicator for statin prescription.

‘This would avoid the costs, ranging from £7 to more than £700 per patient screening, of vascular screening checks recently implemented in the UK.'

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