The National Institute of Health and Clinical Excellence (NICE) has issued guidance on the use of statins in cardiovascular disease. The Guidance is available in full guidance and quick reference summary formats.
The Coronary Heart Disease National Service Framework (CHD NSF) recommended statin use in all patients who have already had a cardiovascular event and those having a 10-year CHD risk greater than 30%. It was also suggested that the treatment threshold for prevention of primary events be rolled back to include patients with a 10-year CHD risk greater than 15% when resources allow.
The NICE guidance continues to recommend that all secondary prevention patients are treated and has made official the primary prevention treatment threshold of 15%. The NICE documentation refers to cardiovascular disease (CVD) risk, which includes stroke, rather than CHD risk. The equivalent values for CVD and CHD risk are:
- 20% CVD risk is equivalent to 15% CHD risk
- 40% CVD risk is equivalent to 30% CHD risk
The NICE guidance is based on a health-economic analysis of the impact of treatment to this lower level of risk in comparison to the costs to the NHS of both the intervention and the "savings" of preventing cardiovascular events. This analysis is based solely upon the use of simvastatin for treating any patient who becomes eligible for treatment under the new guidance.
Action: All clinicians are encouraged to read and implement this NICE Guidance. Effective implementation should be undertaken using Simvastatin 40mg as per the formulary recommendations.