Statins should be used from 1 per cent CVD risk a year, a major new study concludes
Statin gains in millions more
Millions more patients even than new NICE guidance recommends should be taking statins, a major new study
The analysis of data from
the landmark Heart Protection Study found statins were now so cheap their use would be cost-effective far below the current risk threshold.
The researchers called for
patients to be offered statins at a 1 per cent annual risk of a
major vascular event – roughly 12 per cent over 10 years.
They estimated this would put about three million more patients on statins than current guidance recommends, although other experts put the figure far higher.
NICE guidance released a year ago advises statins for all patients at a 20 per cent
10-year risk of cardiovascular disease.
But study author Professor Alastair Gray, professor of health economics at the University of Oxford, said: 'There are people who are currently not being offered [statins] who could benefit and for whom it would be a good investment for the NHS. There is a strong argument for moving the risk threshold down further.'
He added: 'Looking at NICE's numbers, lowering the risk threshold to 1 per cent might increase the potential population to be treated by between two and three million.'
The study findings have divided cardiovascular experts. Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, strongly agreed: 'It's entirely logical – we treat at this level of risk.'
He added he was already instituting statin treatment at the lower level in some patients.
But Professor Bryan Williams, professor of medicine in the department of cardiovascular sciences, University of Leicester, said: 'It's not just about cost-effectiveness – it's about what a population will accept. If we want to lower the threshold we have to understand it would mean probably every man over 40 will be offered a drug.'
He said he thought the current 20 per cent risk threshold for funding statin use was
Professor Gray's study, published early online by the BMJ, looked at the cost-effectiveness of simvastatin 40mg daily versus placebo over five years in 20,536 patients with coronary disease or diabetes.
Lowering thresholds for
• 1998: Joint British Societies guidelines set a threshold of 40 per cent 10-year risk of CVD
• 2000: National Service Framework on coronary heart disease plumps for 30 per cent 10-year risk of CHD – roughly equivalent to the JBS
• June 2005: Draft NICE guidance reduces the threshold to 20 per cent CHD risk – but still sparks controversy
• November 2005: NICE final appraisal determination opts for 20 per cent CVD risk
• December 2005: Final JBS2 guidelines also, as expected, go for 20 per cent CVD risk
• November 2006: Heart Protection Study recommends a threshold roughly equivalent to 12 per cent 10-year CVD risk