July 18, 2014

expert reaction to final NICE guidance on cardiovascular disease and statin use

NICE published its final updated guidance on starting preventive treatment of cardiovascular disease (CVD) advising that the threshold for starting treatment should be halved from a 20% risk of developing CVD over 10 years to a 10% risk, and that once lifestyle factors have been addressed high intensity statin therapy should be offered.

Helen Williams, Consultant Pharmacist & Royal Pharmaceutical Society spokesperson for Cardiovascular Disease, said:

“I welcome the new NICE recommendations aiming to extend the benefits of statins to a broader group of people.  Doctors are being advised to give advice on lifestyle changes and offer statin therapy to people at risk.

“It is important to note that both elements are essential to significantly reduce cardiovascular events.  Healthcare professionals should discuss with patients their individual risk of suffering one of these life changing events and help them to make an informed personal choice about their treatment plan, including drug therapy, based on the benefits and risks of treatment.

“Some have criticised this guidance during its development, implying that there will mainly be gains for the research based pharmaceutical industry – I disagree, the statins endorsed by the NICE group are all available generically, at low cost to the NHS, so there is little advantage here for big pharma, compared to the substantial gains in reduced NHS costs and lives saved.”

Professor Sir John Tooke, President, Academy of Medical Sciences, said:

“The benefits of a healthy lifestyle should be promoted for people at risk of cardiovascular disease, and facilitated by appropriate public health measures.  Whether or not someone takes drugs to diminish their risk is a matter of personal choice, but it must be informed by accurate information on the balance of risk and benefit in their particular case.

“Few would deny the treatment of hypertension, a largely symptomless condition, on the grounds that it was ‘medicalising’ the recipient, despite the fact that lifestyle influences blood pressure.  If treatment of higher levels of blood pressure to diminish stroke and heart attack is acceptable, so too is the treatment of high cholesterol above an evidence-based threshold.

“The weight of evidence suggests statins are effective, affordable and have an acceptable risk:benefit profile. Appropriate drug therapy should not be denied on the basis of an ideological stance against ‘medicalisation’.”

Prof Sir Michael Marmot, Director of the Institute of Health Equity, UCL, said:

“Any intervention that reduces risk of disease and prolongs lives is to be welcomed. That said, we should not simply use pharmaceuticals to treat the results of unhealthy conditions. We have to address the root causes of cardiovascular disease. And these are socially determined and progressively more common the more socially disadvantaged people are. Therefore we need to make significant changes to the environment in which people are born, live, grow, work and age – the social determinants of health.

“Choosing healthy lifestyles is more difficult because our society promotes cheap unhealthy foods, low alcohol prices, and car use instead of walking or cycling. One positive policy example that addresses the social determinants of health is the banning of smoking in public places, which has reduced tobacco use across all social groups. Other examples would include minimum pricing for alcohol, 20 mph speed limits in towns and significant investment in early child development.”

Prof Liam Smeeth, Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine, said:

“Statins are effective at preventing the UK’s biggest killer: cardiovascular disease. The recommendation from NICE to broaden the range of people who should be offered a statin within the NHS is welcome because it will help reduce the numbers of people having heart attacks and strokes. It is important that people are given the opportunity to have a cardiovascular risk assessment and that those people with increased risk are given appropriate information about their risk of disease and how to reduce it, including being offered a statin. Not everyone who is eligible will take the drugs. Some people may try to reduce their cardiovascular risk through healthier eating, more exercise and stopping smoking for example. Some people may try a statin and decide they don’t like them or may just not want to take a tablet every day. However what matters is that more people will now be offered these effective drugs. We know that the more people who take statins long term the less heart attacks and strokes will happen. This is good news for individual patients and good news for the country as a whole.”

Prof Colin Baigent, Deputy Director of the Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, said:

“Many heart attacks and strokes occur without warning in people who have never had cardiovascular symptoms, but by offering cholesterol-lowering treatment to a larger number of people who are at increased risk of such problems these new guidelines from NICE will prevent a great deal of unnecessary personal suffering and expense to the NHS.”

Prof Peter Weissberg, Medical Director at the British Heart Foundation, said:

“Too many people die from cardiovascular disease, and these new guidelines are part of continuing efforts to prevent heart attacks and strokes.

“Doctors will now be able to offer a statin to people at a lower risk, but their prescription is not mandated. Just as important is the emphasis on trying lifestyle changes before considering treatments with drugs.

“Crucially, the guidelines emphasise that preventive strategies should be based on each individual’s risk and needs with a personalised game-plan to help reduce their risk of cardiovascular disease.”

Declared interests

Professor Sir John Tooke:

Public Appointments Held at Present:

1)       Non-executive Director, UCLH NHS Foundation Trust; Chair of the Quality and Safety Committee, 2010-

2)       President, Academy of Medical Sciences, 2011-

3)       Member, National Institute for Health Research Advisory Board, 2007-

4)       Board Member, GMEC (Global Medical Excellence Cluster), 2012-

5)       Board Member, International Advisory Board, Qatar Academic Health Science Centre, 2011-

6)       Academic Director, UCL Partners, 2010-

7)       Member, Medical Schools Council Executive, 2007-

8)       Member, Associate Parliamentary Health Group, 2010-

Previous Public Appointments Held Within the Last 5 Years:

1)       Chair, UK Health Education Advisory Committee, 2005-2011

2)       Chair, Medical Schools Council, 2006-2009

Personal and Business Interests:

Non-executive Director, Bupa; Chair of the Medical Advisory Panel, 2009-2015

Prof Liam Smeeth: “I have undertaken paid advisory work on research methods for GSK. As far as I am aware they do not make a statin.”

Prof Colin Baigent: see this document for details of Clinical Trials Service Unit (CTSU) grants.