Executive summary
* The National Institute for Clinical Excellence (NICE) is the organisation in the UK that sets medical guidelines for every drug, every intervention, and every procedure.
* NICE published guidelines (CG181) for cardiovascular disease (CVD) in July 2014.
* These were consulted upon for a few days in September/October 2023 and a revised version has been issued (NG238).
* The revised guidelines have six key changes:
– Specific cholesterol targets have been set;
– A previously off-label use of a high dose statin is now to be offered unless contraindicated;
– Other cholesterol lowering drugs are recommended in addition to statins (e.g., PCSK9s);
– Ezetimibe particularly should be used more widely;
– Statin doses should be as high as people can tolerate;
– Alternative treatments for CVD (e.g. niacin, omega-3) must not be used.
* The ‘cardioprotective diet’ changed little between CG181 and NG238. The diet section got shorter. The key goals remained – consume less than 30{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497} of one’s diet in the form of total fat and less than 7{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497} in the form of saturated fat. Consume rapeseed oil and spreads etc.
* There were 49 pages of declarations of interest among the panel members.
* The takeaway message from the guidelines was lower cholesterol as much as possible. The panel comprised many people who have an interest in lowering cholesterol.
