NICE recommendation means more people take atorvastatin to prevent heart disease

Atorvastatin is set to become the most prescribed drug in the UK following changes to cardiovascular disease (CVD) prevention guidelines from the National Institute for Health and Care Excellence (NICE).

The guidelines recommend that all patients with a 10% or greater risk of developing CVD over the next ten years should be offered atorvastatin 20mg for primary prevention. This cuts the threshold by half, making an extra 4.5 million patients in England eligible for statins.

GPs will use a cardiovascular risk assessment tool, known as QRISK2, to assess the risk of patients.

Some 7 million people in the UK are taking a statin, costing the NHS £150m each year. Based on 80% patient compliance, NICE estimates that the increased use of statins, offset by the reduction in costs associated with cardiovascular events, would cost the NHS an additional £52m each year.

Atorvastatin is already seeing growth in volume terms. In 2013, it accounted for 18.2m prescription items dispensed in England, while competing product, simvastatin, sat at 39.9m items — being the most dispensed drug in England. However, atorvastatin’s volumes have risen by 6m items compared with 2012, following the expiry of its patent, while simvastatin items fell by 3m from the 42.6m million peak in 2012.

The guidelines also recommend that patients being treated for CVD should be offered the higher dose of 80mg atorvastatin. Patients who are stable on a low- or middle-intensity statin (see ‘Reduction in low-density lipoprotein cholesterol’) should discuss the benefits of switching to a high-intensity statin when they have a medication review, it adds.

Although the guidelines increase the number of patients eligible for statins, it does not mean all patients should receive them, stressed Mark Baker, director of the centre for clinical practice at NICE. “The guidance recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between risks and benefits.”

However, the “weight of evidence clearly shows statins are safe, and clinically and cost-effective,” Baker added.

The new guidance could mean better discussions with patients, said Helen Williams, consultant pharmacist for cardiovascular disease for south London. “The guidance says to offer a statin — which implies a conversation. And that means the patient should be empowered.”

The guidance also recommends that all patients with CVD or at high-risk of CVD should eat a diet in which fat intake is 30% or less of total energy intake, and perform at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous aerobic activity each week.

In 2010 around 180,000 patients died of CVD in England and Wales and the condition cost the NHS in England around £7.9bn.