Clinical update

Statins and cardiovascular disease Essential facts

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Heart disease, stroke and peripheral arterial disease, known collectively as cardiovascular disease (CVD), cause one in three of all deaths in the UK. High levels of low-density lipoprotein (LDL) cholesterol can lead to hardening of the arteries, a risk factor for CVD. Statins are a group of drugs that act on the liver to lower LDL cholesterol rates in the blood. As many as seven million people in the UK currently take statins, at a cost of £285 million a year, according to the National Institute for Health and Care Excellence (NICE).

ALAMY

NICE consultation on statin guidance (2014) tinyurl.com/ lipid-modification

What’s new

Signs/symptoms

Under draft updated guidance being considered by NICE, many more people could be prescribed statins to prevent CVD. NICE is consulting on whether to lower the risk threshold for offering statins so that patients with a 10 per cent risk of developing CVD within ten years could be prescribed the drugs. The current threshold is 20 per cent. NHS Choices says media reporting that ‘millions more’ people would be on statins was misleading – NICE estimates the number to be in the thousands.

Coronary heart disease can lead to angina, causing chest pain, and myocardial infarction (heart attack). Heart attack symptoms include chest pain, shortness of breath and feeling weak or lightheaded. The key symptoms of stroke include facial droop on one side, garbled speech and an inability to lift the arm and keep it raised. The most common symptom of peripheral arterial disease is pain in the legs when walking.

Causes/risk factors

Assessing those at risk of CVD is a vital part of nurses’ work, particularly in primary care. The current NICE guidance says that before offering statins, modifiable CVD risk factors should be considered. It advises healthcare professionals to check smoking status, alcohol consumption, blood pressure, weight, cholesterol, fasting blood glucose and renal function. The new guidance recommends doctors use the risk assessment tool QRISK2, and, if necessary, prescribe a statin called atorvastatin for prevention and treatment.

CVD develops when fatty substances build up in the coronary arteries. The deposits are made up of lipids (cholesterol and other fats), calcium and fibrous tissue. As people age, the deposits can lead to arteries in the heart, brain and legs becoming severely narrowed and diseased. CVD predominantly affects people over 50 years of age. Risk factors include age, gender, family history of CVD and ethnic background. Modifiable risk factors include smoking, raised blood pressure and high levels of cholesterol.

Expert comment

Maureen Talbot is a senior cardiac nurse at the British Heart Foundation

NURSING STANDARD

How you can help your patient

‘CVD is responsible for long-term ill health and hundreds of deaths every day. Practice nurses and other nurses in primary care should be doing a full cardiovascular assessment, not just checking if patients have high cholesterol. They should be assessing a patient’s diet, blood pressure, weight,

Current NICE guidance www.nice.org.uk/ nicemedia/pdf/ CG67NICEguideline.pdf Articles from Nursing Standard An overview of cardiovascular disease risk assessment Westerby R (2011) rcnpublishing.com/ doi/abs/10.7748/ ns2011.11.26.13.48.c8845 Use of statins to reduce the risk of cardiovascular disease in adults Ford H (2013) rcnpublishing.com/ doi/abs/10.7748/ ns2013.05.27.39.48.e7391 Reducing cardiovascular disease risk: cholesterol and diet Walker J (2013) rcnpublishing.com/ doi/abs/10.7748/ ns2013.09.28.2.48.e7747

whether they are active and if they smoke. Then they can give advice about tackling these where appropriate. ‘Many patients will use the suggestion that they may have to go on statins to consider a healthier lifestyle, so it is important to make sure they get this advice and the chance to change.’ march 19 :: vol 28 no 29 :: 2014 19

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