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It sometimes pays to ignore NICE guidance

By Dr Livingstone

18 Sep 2018

It looks as though GPs have been vindicated in their head-in-the-sand approach to blanket statin prescribing in older people, writes The Pharmacist’s GP blogger Dr Livingstone

So what, do you suppose, was the reaction of the average GP to the National Institute for Health and Care Excellence (NICE) guidance of 2014 entitled, ‘Cardiovascular disease: risk assessment and reduction’?

You know, the one that suggested we should consider offering statins as primary prevention to all patients over 85, because their age alone puts them at significant risk of cardiovascular disease? And that advised in ‘younger’ elderly we should calculate their risk using the ‘QRisk’ score and offer statins to those above 20%, that is to say, just about all?

In other words, in case you’re finding this hard to follow, what do you suppose was our reaction to NICE’s advice that we should start suggesting statins to the majority of fit and well elderly people?

Correct. We ignored it. Or rather, we read it, we blinked hard, and we read it again. And then we thought…nah. It just didn’t feel right. It was, let’s face it, a pretty momentous bit of public health guidance but somehow, by shutting our eyes, putting our fingers in our ears and humming loudly, we managed to pretend it wasn’t happening.

A good thing, too. Because, guess what? Some recent heavyweight research in the British Medical Journal (BMJ) involving many thousands of elderly patients put on statins for primary prevention shows that, by and large, it doesn’t work.

So our intuition and reluctance has been proved right and a significant number of the elderly have been saved unnecessary ill popping, muscle ache and medicalisation. And we’ve saved the NHS a shedload of cash.

Of course, one or two may have slipped through the net. So if they turn up in your pharmacy, shuffling disconsolately and dutifully in to pick up their next batch of cholesterol zappers, do tell them the good news. Liberate them from their statin shackles. Just pray they don’t have an infarct the following week.

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