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Statins imageAugust 3 2017

NICE has released a new Quality Standard listing atorvastatin “as the preferred statin to offer patients because it is both clinically and cost effective.”

The recommendation is made in QS5 relating to chronic kidney disease in adults. It makes quality statements about identification and monitoring, blood pressure control, and statins for people with CKD.

It expects health professionals to monitor the blood pressure of adults with CKD and be aware of the recommended ranges. They should also “help people keep their blood pressure within the recommended range, for example, by starting or adjusting treatment, or advising on lifestyle changes.”

Health professionals should “check whether adults with CKD are taking a statin, and discuss the risks and benefits of starting statin therapy if not.” Atorvastatin 20mg should be offered and the dose increased if an adequate response to treatment is not achieved and eGFR is 30 ml/min/1.73 m2 or more.

If the patient is not able to tolerate atorvastatin 20mg or reports adverse effects, the health professional should discuss alternative options such as stopping the statin or changing the dose or type of statin.

Professor Gillian Leng, deputy chief executive at NICE, said: “We know that a high number of people with long-term kidney problems will develop cardiovascular disease. This means they have an increased risk of suffering a fatal heart attack or stroke.

“It is important for healthcare professionals to speak to patients about their treatment options. The effectiveness of statins is now well proven, as is their long-term safety. They may appeal to a lot of people who are at risk.”

A new paper in the British Journal of General Practice has added to the call for greater uptake of statins. Researchers have looked at how the 2014 NICE cholesterol guidelines are being applied, in a cross-sectional study using a sample representative of the English population aged 30–84 years.

“Even with optimal risk factor levels, males of different ethnicities would exceed the 10% risk threshold between the ages of 60 and 70 years, and females would exceed the threshold between 65 and 75 years,” the researchers found. “Under the NICE guidelines, 11.8 million males and females (37% of the adults aged 30–84 years) would require statin therapy, most of them (9.8 million) for primary prevention. When analysed by age, 95% of males and 66% of females without CVD in ages 60–74 years.”

The British Heart Foundation points out that the study suggests that 6.3 million people are missing out on the potential benefits of statins.

Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, commented: “There is no question that statins lower people’s risk of heart attack and stroke. This study suggests that an estimated 6.3 million people are missing out on the potential lifesaving benefits of statins. If these people were taking statins, we could not only potentially prevent 290, 000 heart attacks and strokes, but also reduce the burden of these events on both the NHS and people’s lives.”

Links:
NICE QS announcement                
NICE QS5              
P Ueda et al. ‘Application of the 2014 NICE cholesterol guidelines in the English population: a cross-sectional analysis’. BrJGenPract 31 July.  2017 
BHF comment 

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