Statins could be offered to 15 million more people in England under new guidance

Millions more people with a future risk of heart attack and stroke may be able to choose whether they take statins under new guidance.

The National Institute for Health and Care Excellence (Nice) said that following a conversation with a doctor, people who are found to have a degree of risk will be able to decide whether the clot-busting drugs are for them.

Up until now, people with a 10% or higher risk over ten years of suffering a cardiovascular event - such as a heart attack or stroke - are routinely offered a statin to combat the chances of falling ill.

But evidence considered by Nice suggests that even people well below this threshold could benefit from a statin.

Nice estimates there are around 15 million people in England aged 25 to 84 with a ten-year risk up to 10%, though it says people must have a degree of risk to be prescribed a statin.

Under the guidance, people would tend to have their risk of heart disease, heart attack or stroke picked up during routine appointments with their GP, such as during an over-40 health check, a cholesterol check or a blood pressure check.

Medics calculate the risk of a cardiovascular event over the next ten years using a QRISK3 calculator, which the public can also find online.

Included within this is measurements on whether somebody smokes, their cholesterol levels, blood pressure and weight (body mass index).

Nice is suggesting that doctors continue to persuade people with a risk lower than 10% to live a healthier lifestyle, such as losing weight or stopping smoking, to bring their risk under control.

But if after that a statin still looks like a good option, one can be prescribed.

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Nice said that although statins can sometimes cause side-effects, such as muscle pain, the best evidence shows most people do not experience this.

According to Nice, many more people will get muscle pain whether they take statins or not than have muscle pain caused by the drugs.

The new guidance, published on Thursday, says doctors should consider prescribing atorvastatin 20mg for people with a ten-year risk of less than 10%, where there is patient preference for taking a statin or concern that risk may be underestimated.

Nice’s estimates suggest that for every 1,000 people with a risk of 5% over the next ten years who take a statin, about 20 people will not get heart disease or have a stroke because they take the pill.

The figure doubles to 40 for people with a risk of 10%, and for people with a risk of 20%, Nice estimates that, on average, around 70 people would not get heart disease or have a stroke in the next ten years.

Statins will continue to be routinely offered at the official risk threshold of 10%.

Paul Chrisp, director of the centre for guidelines at Nice, said: "What we’re saying is that for people with a less than 10% risk over ten years of a first heart attack or stroke, the decision to take a statin should be left to individual patients after an informed discussion of benefits and risks.

"The evidence is clear, in our view, that for people with a risk of 10% or less over ten years, statins are an appropriate choice to reduce that risk. We are not advocating that statins are used alone.

"The draft guideline continues to say that it is only if lifestyle changes on their own are not sufficient, and that other risk factors such as hypertension [high blood pressure] are also managed, that people who are still at risk can be offered the opportunity to use a statin, if they want to."

Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said: "I agree statins are well proven to lower cardiovascular outcomes cost effectively at thresholds less than 10%, so this new guidance makes sense.

"However, we need also to concentrate more on helping people live healthier lives and not just longer with more diseases.

"Hence, parallel work to help people improve their lifestyles, walking more, eating better, is needed to maximise health gains."