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Should NICE’s statins guidance be followed to the letter?

10 Aug 2017

Recent research in the British Journal of General Practice (BJGP) has shown that over six million more people in England would be on statins if doctors slavishly followed National Institute for health and Care Excellence (NICE) guidance. Yes, that’s right, over six million – about 200 per GP. Who’d have thought it? Well, us GPs, actually.

After the latest NICE guidance lowered the threshold for intervention from 20% to 10%, it took only the time required to fire-up our QRISK2 calculators to realise that we’re in danger of prescribing statins for huge numbers of people.

This has been confirmed and quantified by the BJGP paper, which shows that 95% of males and 66% of females aged 60-74 would be entitled to statins. And over the age of 75, it’s everyone.

We’ve responded in that pragmatic GP way of ours, i.e. we’ve ignored it. We had to. Quite apart from any clinical, philosophical or ethical objections, there was the small issue of workload to consider.

Because, of course, it’s not just a matter of starting patients on a statin. There’s the explanation, the shared decision making, the follow-up, the monitoring, the management of side effects, the setting up of repeat templates etc, etc.

There are only three rational responses to the NICE guidance, and this latest research should focus our minds:

  1. We reject it on the basis that it’s unrealistic.
  2. We view it as the tipping point for implementing the old idea of the ‘Polypill’ – the ‘put it in the tap water’ approach of dishing out to everyone over the age of 55 a pill containing a variety of cardiovascular-friendly constituents to achieve blanket coverage, maximum public health benefit and minimum hassle.
  3. We delegate the new and increasingly onerous role of statin gatekeeper to someone else. To someone who has the time, the inclination and the energy. To someone like you pharmacists, in other words. You’re looking for new roles, aren’t you? Sure, you’ll have to pop the odd blood vessel battling for funding. But I can lend you a used QRISK2 calculator.

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