Draft guidance from NICE, if approved, could soon see the vast majority of adults with diabetes being prescribed statins.
Under the current guidance for cholesterol treatment, people with diabetes are not specifically covered but in the new draft guidance, treatment for people with diabetes is explicitly defined.
In addition to recommending that most people with diabetes take statins, the draft guidance, which is now open to consultatio, would also see many more people, without diabetes, offered statins. This would mean that around 1 in 4 adults within the UK would be prescribed statin therapy.
The current guidance states that anyone, with or without diabetes, that has a 20% risk of developing heart disease within 10 years should be offered statins, unless they are otherwise contraindicated for statin treatment. The new guidance stipulates that only 10% risk would be enough to justify statin treatment.
Some of the key points, relevant to people with diabetes over 18 years old, from the draft guidance include:
Doctors are recommended not to offer people with either type 1 or type 2 diabetes to take fibrates, niaci, omega 3 fatty acids, plant sterols or plant stanols for the treatment of cardiovascular disease.
People with type 1 diabetes will be offered high-intensity statin treatment –starting at 20mg of atorvastatin.
People with type 2 diabetes will be offered high-intensity statin treatment if they have a 10% risk of developing heart disease within the next 10 years –starting with a dose of 80mg of atorvastatin
The theory behind a wider number of people taking statins is that the reduction in risk of heart disease should outweigh any disadvantages of taking the drugs. The use of statins is not without controversy.
Professor of public health at LSE (the London School of Economics), Shah Ebrahim, has stated: “It is a concern to have to mass medicalise the whole of the British public in this way. A lot of this is about the food we eat – the saturated fat and processed foods and about the failure to control the food industry. In the long term, we need to move way from the idea that ‘drugs for everybody’ is the way to tackle this problem.”
Statins are regarded as well tolerated drugs but common side effects can include muscle weakening, elevated blood glucose levels, memory impairment and cataracts.
One of the key roles of NICE is to ensure healthcare provided by the NHS is cost effective. Treating heart disease is undoubtedly costly. The British Heart Foundation notes that economic estimates for the cost of treating heart disease in the UK is around £9 billion a year, with two thirds of this cost being for hospital care.
Currently, the cost of statins is significantly less than the overall costs of treating heart disease but at £450 million a year, prescribing statins is still more expensive than the combined costs of insulin and blood glucose test strips for diabetes, which is around £400 million.
Controversy also exists over the amount of influence the drug companies have over NICE guidance. Senior lecturer in public health at Harvard University, John Abramso, points out that all the research on statins is funded by the pharmaceutical companies. In addition, GPs receive financial incentives for prescribing greater numbers of statins. It is no wonder, therefore, that the UK already has the second highest rate of prescribing statins out of all Western countries.
