Thu, Dec-14-23, 03:30
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Plan: Muscle Centric
Stats: 238/153/160
BF:
Progress: 109%
Location: UK
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Millions will be told to increase their dose of statins
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Millions will be told to increase their dose of statins
NHS guidance, aimed at cutting cholesterol levels, could mean 145,000 fewer heart attacks and strokes in the next decade
Two million people will be advised to boost their statin dose in order to slash their cholesterol levels under new NHS targets.
The National Institute of Health and Care Excellence (Nice) said the guidance could mean 145,000 fewer heart attacks, strokes and other cardiac incidents in the next decade.
For the first time, Nice has set specific cholesterol targets for those who have already suffered a cardiovascular event, such as a heart attack or stroke.
GPs will be told to offer higher doses to such patients during their check-ups.
Until now, Nice has only called for such patients to aim for at least a 40 per cent reduction in non‑high-density lipoprotein (non-HDL) cholesterol.
Under the new guidance, some two million people already taking statins will be advised to take heavier doses, or prescribed additional drugs including injections to cut their risk.
Cholesterol treatments ‘escalated’
For low-density lipoprotein (LDL) cholesterol levels – often known as bad cholesterol – the target is 2.0 millimoles per litre (mmol/L) or less. The target for non-HDL will be 2.6 mmol/L or less.
Both of the targets are far lower than the general advice to the public, which says LDL levels should be below three mmol/L, while non-HDL levels should be below four.
The new guidance says treatments to cut cholesterol should be “escalated” in an attempt to hit the new targets.
For those who have had a heart attack or stroke, 80mg of atorvastatin will normally be offered by GPs, unless there is thought to be a high risk of adverse effects or a reaction with other drugs. If statins are not enough, other treatments should be considered, it says.
These include a prescription-only tablet which helps stop the body from taking in cholesterol from food (Ezetimibe), a lipid-lowering injection called Inclisiran, or two drugs known as PCSK9 inhibitors (Alirocumab and Evolocumab), which block a protein made in the liver linked to high cholesterol.
The new guidance means GPs will need to keep a close check on cholesterol levels and consider prescribing extra drugs.
While healthy people are expected to get their cholesterol checked by GPs every five years from the age of 40, annual checks should be carried out for those who have suffered a cardiac event.
Nice said up to 2.1 million people could benefit from the new targets.
Reduce deaths
Earlier this year, Nice said that anyone who wants to take statins to ward off heart disease should have the option to do so, amid concern about surging deaths among the middle-aged.
Prof Jonathan Benger, Nice chief medical officer, said: “Improving the control of cholesterol in a larger number of people will further reduce deaths from heart attacks and strokes. This guideline will help clinicians talk through the options with their patients to achieve the best outcomes.”
Monitoring of cholesterol levels usually takes place in GP surgeries.
The decision to prescribe an additional treatment should be taken by GPs or other primary care staff following a discussion with the patient, Nice said.
Those being offered statins should be advised that the risk of side effects such as muscle pain, tenderness or weakness is “small” with an “extremely low” risk of muscle breakdown.
Last year a landmark study by Oxford University found that the drugs cause muscle pain for one in 100 people. In most cases when people taking statins had aches and pains, the cause was the creaks of old age, researchers concluded.
Dr Sonya Babu-Narayan, the associate medical director at the British Heart Foundation, welcomed the guidance.
She said: “Decisions about medications and lifestyle changes you can make to reduce your risk of cardiovascular disease should be based on a conversation with your GP.”
But some scientists said the new targets did not go far enough. Prof Kausik Ray, the deputy director of the Imperial Clinical Trials Unit at Imperial College London, said the guidelines could cause confusion, being higher than some targets already in use in the NHS, and those recommended by the European Society of Cardiology and American Heart Association.
NHS pathways being used by GPs already recommend a target of 1.8 mmol/L for LDL cholesterol, for those who have suffered heart attacks and strokes, while the European Society of Cardiology and American Heart Association have targets of below 1.4 mmol/L, he said.
Dr Shahed Ahmad, the NHS national clinical director for cardiovascular disease prevention, said the new targets would bring “welcome clarity” to NHS clinical teams and their patients.
He said: “The NHS is already supporting hundreds of thousands of people to manage their cholesterol through a range of clinically-appropriate treatments, while pharmacists are also offering blood pressure checks to around one million people a year, all of which is helping to prevent heart attack and strokes.”
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Who is this guidance for?
The latest Nice guidance is aimed at millions of people – those at risk of heart disease, and those who already have it. But the most significant changes in it are for those who have already had a heart attack, stroke or other cardiovascular event, such as angina. Such patients will be set new cholesterol targets with GPs urged to offer higher doses of statins, or extra drugs, if such doses cannot be tolerated or do not have sufficient effect.
What are the new targets?
The target for LDL cholesterol levels is 2.0 mmol/L or less.
Alternatively, there is a target for non-HDL to be 2.6 mmol/L or less. This figure measures all types of bad cholesterol combined.
Both of the targets for those who have had a heart attack or stroke are far lower than the general health advice to the public, which says LDL levels should be below three mmol/L, while non-HDL levels should be below four.
What are the side effects of statins?
Last year a landmark study by Oxford University found that the drugs cause muscle pain for one in 100 people. One in four people taking statins were found to have aches and pains – but the vast majority were creaks of old age, researchers concluded.
However, the risks of side effects do increase with higher doses.
Nice said that if adverse effects were reported by those taking a high intensity statin, patients might be advised to stop taking the drugs, and starting again when symptoms have resolved, to see if the statins truly were the cause.
In such cases, a switch in type of statin, or a lower dose, or lower intensity of drug should be considered, the guidance says. Patients should also be asked if they have suffered from unexplained muscle pain before they start the drugs, with checks on enzymes in the blood which might point to other problems.
What drugs could be offered to cut cholesterol?
For those who have had a heart attack or stroke, 80mg of atorvastatin will normally be offered by GPs, unless there is thought to be a high risk of adverse effects or a reaction with other drugs.
If statins are not enough, other treatments should be considered, Nice says.
These include a prescription-only tablet which helps stop the body from taking in cholesterol from food (Ezetimibe), a lipid-lowering injection called Inclisiran, or two drugs known as PCSK9 inhibitors (Alirocumab and Evolocumab), which block a protein made in the liver linked to high cholesterol.
Is there any lifestyle advice?
Plenty. The guidance says those at risk of heart disease and those suffering from it should be advised to make lifestyle changes.
In particular, the new guidance also says anyone at risk of cardiovascular disease should be advised to eat a diet where total fat intake is 30 per cent or less of total energy intake, with saturated fats making up no more than 7 per cent. GPs are asked to assess the readiness of patients at risk of heart disease to make lifestyle changes, including to their diet, activity, alcohol and smoking consumption.
However, it says those who have had a heart attack or stroke should not delay statin treatment.
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https://www.telegraph.co.uk/news/20...sh-cholesterol/ |
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