LONDON -- May 29, 2008 -- The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Primary Care have issued new guidance to the National Health Service in England and Wales on the identification of people at risk of cardiovascular disease (CVD) and on the use of lipid lowering drugs to reduce that risk.
The NICE guidelines address the identification of those at high risk (primary prevention) and the modification of lipids in these people and in people with established CVD (secondary prevention).
Guidelines for the primary prevention of CVD include using a modified Framingham 1991, 10-year risk equation to identify people aged 40 to 75 years who are likely to be at high risk of CVD. Also, before offering drugs to reduce cholesterol levels, all other modifiable risk factors should be considered and their management optimised if possible.
Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. Treatment should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen.
Guidelines on the secondary prevention of CVD recommend that drugs be used to reduce cholesterol levels and should not delayed by management of modifiable risk factors. For adults with clinical evidence of CVD, statin therapy is recommended.
John Robson, MD, General Practitioner and Chair of the Guideline Development Group, NICE, said, "This [guideline] is a major public health initiative and will be a welcome addition to the Government's vascular programme as it ensures an efficient and equitable method of targeting treatment to those most likely to benefit."
SOURCE: National Institute for Health and Clinical Excellence
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