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Millions more to be offered statins
Millions more people in the UK could be prescribed cholesterol-lowering statins in a bid to prevent more cases of heart disease, heart attacks and strokes.
In draft guidance to the NHS, which is subject to consultation, the National Institute for Health and Care Excellence (Nice) has cut the threshold in half for when doctors should consider prescribing the drugs.
Statins are taken by as many as seven million people in the UK but this could rise dramatically - with experts predicting as many as five million more may have them prescribed.
At present, people with a 20% risk of developing cardiovascular disease within 10 years are offered statins, but this is being cut to include all people with a 10% risk of developing cardiovascular disease within 10 years.
While Nice has yet to start work on how many extra people this could affect, evidence from Oxford University researchers shows millions more could take the drugs.
A 2012 Oxford University study, published in The Lancet medical journal, showed that even very low-risk patients benefited from statins.
Rory Collins, professor of medicine at Oxford University, worked on the research and said the number of people who could begin taking statins as a result of the new Nice guidance "would be in the the order" of around five million.
He added: "The evidence is very strong that the treatment is cost-effective at these lower levels. Doctors are now in a position to offer statins on this basis."
He said it was up to individual patients to decide whether they wanted to take statins, based on their risk assessment, but Nice's strategy would "reduce the burden on the health service".
He went on: "People say you are medicalising the population by recommending statin use at these lower levels.
"That's complete nonsense. This remains a choice for the patient, it's not mandatory."
He said doctors and patients could work together to understand how much benefit an individual patient would receive from statins.
"If they are at high risk then doctors will be saying to patients they will get a big benefit, but at lower levels the benefits will be smaller and the patient has the choice," he said.
"Before, if the patient had lower levels of risk - despite it being cost-effective for them to get the treatment - they would not have had that choice."
Professor Colin Baigent, from the Oxford University team, calculated that lowering the threshold to a 10% risk - as Nice now proposes - would lead to around five million more people in the UK taking the drugs.
This in turn would save 2,000 lives and prevent 10,000 heart attacks or strokes every year, he said.
Another reason behind Nice's new recommendation is that the price of statins has dropped considerably in recent years to just a few pence per pill.
Statins are a group of medicines that help lower rates of low-density lipoprotein (LDL) cholesterol - so called "bad cholesterol" - in the blood.
They do this by cutting production of LDL cholesterol inside the liver.
High-rates of LDL cholesterol are linked to hardening and narrowing of the arteries, which can cause heart disease, heart attacks and stroke.
People can lower their risk naturally by eating a healthy diet, low in saturated fats, and increasing the amount of omega 3 fatty acids in their diet.
The new Nice guidance says doctors should encourage at-risk patients to stop smoking, cut down on alcohol, take exercise and eat a healthy diet.
Once these factors have been addressed, high intensity statin therapy should be offered to patients.
According to Nice, as many as seven million people in the UK are on statins, at an estimated annual cost of £450 million.
Professor Mark Baker, director of the centre for clinical practice at Nice, said: " People should be encouraged to address any lifestyle factors such as smoking, drinking too much or eating unhealthily. We also recommend that statins are now offered to many more people - the effectiveness of these medicines is now well proven and their cost has fallen."
Prof Baker said as well as taking statins, people with raised cholesterol levels and high blood pressure should reduce the amount of foods containing saturated fat they eat, such as meat, cheese and milk.
He said they should exercise more, stop smoking and control their blood glucose levels by reducing their intake of sugar and by losing weight.
According to the NHS, minor side effects of statins include an upset stomach, headache or insomnia. More serious side effects are rare but include kidney failure.
Professor Peter Weissberg, medical director at the British Heart Foundation, said: "Reducing your cholesterol level, whether that's through medication or lifestyle changes, will reduce your risk of cardiovascular disease.
"The current guidance weighed the benefits of taking a statin against what was then the considerable cost to the health service. This pragmatic decision made sure that those of highest risk benefited.
"However, as most people who have a heart attack or stroke have average cholesterol levels and since statins are now much cheaper it makes sense to reconsider the threshold."
A 2012 study from the British Heart Foundation found that 36% of people were failing to take their statins.
Some 28% said they stopped because their symptoms had vanished while 23% said they had suffered side-effects.
Cardiovascular disease is the leading cause of death in England and Wales. In 2010, one in three people died from it.
The NHS estimates that statins save 7,000 lives a year in the UK.
The guidance from Nice covers England and Wales.