December 14, 2023

expert reaction to updated cholesterol treatment guidance, as published by NICE

NICE have published updated cholesterol treatment guidance. 

Prof Kausik Ray, Professor of Public Health and Deputy Director of the Imperial Clinical Trials Unit, Imperial College London, said:

“Whilst the recent update on recommending a lower LDL-C target is welcome for patients. There are several discrepancies with major guidelines. Firstly most major guidelines like ESC/ Aha recommend < 1.18 mmol/L or ideally < 1.4mmol/L for LDL-C this means the equivalent non-HDL-C are 2.6mmol/L or 2.2 mmol/L. The NHS pathways recommend also <1.8mmol/L, so we hope this does not cause confusion especially in primary care. An LDL or 2.0 equates to a non-HDL-C of 2.8mmol/L.

“The key here is even if we aim for < 2.0mmol/L (a good thing) this means we need to use combination therapies like blood pressure lowering does. The models used all cause mortality rather than CV death so the cost effectiveness threshold of 2.0 may actually be incorrect and likely underestimates the benefit than if Cv death were used. This is because LDL-C correlates better with CV death than deaths from all cause which include non-CV deaths.”

*‘2.1 million people with cardiovascular disease could benefit from a new cholesterol treatment target recommendation’ was published by NICE at 00:01 UK TIME on Thursday 14 December which is also when the embargo will lift.

Declared interests

Prof Kausik Ray: “Prof Kausik Ray has consulted for and participated in trials of every class of cholesterol modification therapy in the past 25 years|”