The National Institute for Health and Clinical Effectiveness (NICE) published a health technology appraisal on statins in January 2006. This took account of all available evidence and concluded that it was effective to intervene with statin therapy in patients who scored a 20 per cent. or greater 10-year risk of developing cardiovascular disease, regardless of the starting cholesterol.
NICE is currently working on a guideline on lipid control, due for publication next year, which is also looking at the issue of risk assessment.
There are a number of different risk assessment tools for coronary heart disease (CHD) in use in England. Most of them derive from the Framingham prediction equations, which estimate CHD risk based on patients' age, gender, blood pressure, total cholesterol, high-density cholesterol, presence of diabetes and smoking habit. Relative risk reductions in CHD events in the statin trials appear similar regardless of baseline risk and baseline cholesterol except where baseline cholesterol is less than 5.0 mmol/l when the relative risk reduction is less. This implies that the best way to target patients for cholesterol control and statin therapy to reduce CHD risk is to calculate absolute risk.