Guidance from the United Kingdom’s National Institute for Health and Care Excellence (NICE), if adopted, would mean an additional 4.5 million people will take statins, which the group says could prevent up to 28,000 heart attacks and 16,000 strokes annually.

NICE recommends clinicians order a full lipid profile to assess the need for statins, including measuring total cholesterol, HDL cholesterol, non-HDL cholesterol, and triglycerides, but it says a fasting sample is not required. Based on those results, the guidelines suggest practitioners determine the patient’s risk using the QRISK2 algorithm, which is available online, to calculate the risk of heart attack or stroke over the next 10 years. Those who have a 10% or greater risk of developing cardiovascular disease over the next decade should be offered atorvastatin, 20 milligrams. Also, doctors should discuss lifestyle modifications and other modifiable risk factors prior to prescribing the medication.

“Doctors have been giving statins to ‘well people’ since NICE first produced guidance on this in 2006. We are now recommending the threshold is reduced further,” said Mark Baker, professor and director of the Centre for Clinical Practice, in a prepared statement. “The overwhelming body of evidence supports their use, even in people at low risk of cardiovascular disease. The effectiveness of these medicines is now well proven and their cost has fallen.”

The guidelines, which received worldwide press, were met with mixed reaction. The Royal College of General Practitioners expressed concern about the increased workload the guidelines could mean for its members. “By treating more people with cardiovascular disease in their local communities, we have the potential to save the [National Health Service] a fortune by avoiding hospital admissions and surgical interventions for heart disease,” it said in a prepared statement. “But [general practitioners] are at breaking point and we cannot be expected to keep on doing more and more without more funding and more GPs.”

As CLN reported in February, guidelines issued in the United States in 2013 by the American Heart Association and American College of Cardiology were similarly controversial. These guidelines introduced a new risk calculator and recommended primary prevention statin treatment in individuals without clinical cardiovascular disease (CVD) but who have elevated low-density lipoprotein cholesterol (LDL-C) levels and an estimated 10-year CVD risk of at least 7.5%. The documents also moved away from statin treatment based on targeted LDL-C levels.

Read the new NICE guidelines.