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New NICE cholesterol targets could benefit over two million heart disease patients

New NICE cholesterol targets could benefit over two million heart disease patients

Over 2 million people with heart disease could benefit from new cholesterol targets and follow-up treatment recommended in new NICE guidance released today.

The updated final guidance will seek to improve the control of cholesterol levels in patients with cardiovascular disease (CVD).

The targets for cholesterol levels and treatment will be implemented by a GP or other primary care clinicians in patients with CVD in an effort to prevent further heart attacks or strokes.

The new guidelines follow a 2022 NICE consultation on a draft treatment target for cholesterol levels. This aimed to establish cholesterol targets that could be used in general practice measurement frameworks. Although the stakeholders supported an absolute target for cholesterol to guide treatment options, no consensus on what this target should be was reached at the time. Today’s guidelines offer clinicians an absolute target to work towards.

CVD is the leading cause of death worldwide, accounting for 31 per cent of all global deaths. Public Health England (PHE) figures show that cardiovascular disease is the cause of 1 in 4 deaths in England, and yearly healthcare costs relating to CVD are estimated at £7.4 billion.

Patients who have experienced a heart attack or stroke are currently advised to undertake secondary prevention treatment, which involves taking statins as a first precaution. If the statins do not successfully reduce cholesterol levels, healthcare workers can consider other treatment options in consultation with the patient. Around 2.6 million people in England have CVD, and approximately 2.1 million people are prescribed cholesterol-lowering therapies to help treat and manage elevated cholesterol associated with the condition, although PHE reports ‘an absence of coordinated action to tackle the secondary prevention of CVD.’

The new guidance recommends specific targets for cholesterol levels when additional treatments are being considered between clinicians and patients. For secondary prevention of CVD, the guidelines suggest keeping patients’ low density lipoprotein (LDL) cholesterol levels at 2.0 mmol per litre or less. Alternatively, the non-HDL cholesterol levels should be targeted at 2.6 mmol per litre or less.

As the new targets are put in place, enabling more people to reach the 2.0 mmol per litre LDL target, NICE estimates that the number of CVD incidents in England could be reduced by between 50,000 and 145,000 events over ten years, resulting in fewer strokes, heart attacks, and premature deaths.

Professor Jonathan Benger, NICE chief medical officer, said: ‘Improving the control of cholesterol in a larger number of people will further reduce deaths from heart attacks and strokes. This guideline will help clinicians talk through the options with their patients to achieve the best outcomes.’

NICE states that the recommendations are not mandatory, and whilst the guidelines should be considered, the patient’s individual needs, preferences, and values must be considered alongside the new targets.

Professor Benger added: ‘We are focussed on providing useful and useable guidance for healthcare practitioners to help them and their patients make informed choices about their long-term healthcare.’


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