Cardiovascular Disease - Lipids

Changes/additions to materials (reviewed 27/05/10):

The May edition of Drug Safety Update includes an article advising healthcare professionals that the product information for simvastatin has been updated to highlight the increased risk of myopathy associated with the 80mg/day dose. Blog No. 1423 discusses the place in therapy of simvastatin 80mg/day in the context of the MHRA advice, NICE guidance and the current evidence base, including the risks of other statins at high doses.

29th March 2010: NICE has reissued its guideline on cardiovascular risk assessment and lipid modification (CG67) removing the recommendation to use a specific method for risk estimation (based on the Framingham equation).  NICE considered new evidence relating to QRISK but concluded that it was not able to recommend one cardiovascular risk estimation method over another. It has therefore left the decision to the NHS locally to use the method best suited to their requirements. All other recommendations in the guideline are unchanged. 

Ezetimibe and cancer — reassuring data
As we have blogged, an analysis of post-marketing adverse event reports did not find any increased risk of cancer with ezetimibe▼ compared with statins, either alone or when taken in combination with simvastatin. Although these data are reassuring, it would seem sensible to use ezetimibe▼ only with caution because there is no published evidence of its benefit on clinically important outcomes such as cardiovascular events and its long-term safety is unknown. Prescribers should continue to use evidence-based statins (e.g. simvastatin 40mg/day) first-line in most patients who require a lipid-lowering agent.

A MeReC Bulletin on lipid-modifying treatment is now available. It:

• addresses the similarities and differences between NICE guidance for people with and without type 2 diabetes
• provides clarification on NICE’s recommendations regarding thresholds for intensifying treatment
• discusses the evidence base for high-intensity statins, for rosuvastatin and for ezetimibe▼, the reliability of single cholesterol measurements, and the side effects of statins.

Lipids Data Focussed Commentary

We have produced data-focussed commentaries to highlight areas where there appear to be differences between the evidence-base, as described elsewhere on this floor, and current clinical practice. These resources can be read on the screen by clicking the 'flash' version, or by downloading and printing the 'PDF' version.

This commentary covers high cost and low cost statin usage, rosuvastatin and ezetimibe.