CSH responds to NICE consultation on Cardiovascular disease: risk assessment and reduction

The National Institute of Health and Care Excellence (NICE) has been consulting on a draft guideline for cardiovascular disease risk assessment and reduction. The draft recommendations include prescribing statins to a much larger group of patients at a lower risk threshold than previously. CSH has responded to the consultation, welcoming the increased focus on prevention (which is the first principle of sustainable healthcare) but raising some concerns about the prioritisation of medication over lifestyle interventions.

Here are our key points:

• Levels of obesity and type II diabetes continue to rise, suggesting that current approaches to lifestyle advice are not effective. Investment at public health level is needed to address inequalities and enable the population to make healthy choices in relation to food and physical activity. This would represent a more sustainable option than reliance on medication.
• There is a risk that due to pressure on health services, patients given a choice of lifestyle change or medication may be prescribed medication, when prolonged lifestyle change is likely to be effective without any of the risks or adverse effects of taking medication. Prescribing for people at low risk creates a dependency on health services for ongoing prescribing and monitoring over a long period of time.
• People with a CVD risk <10% represents a large cohort, estimated to be up to 15 million people. This potentially represent a further significant burden on primary care appointments. There is a risk of low adherence to statins, resulting in potential medicines waste and pharmaceutical pollution. The carbon footprint of the medication prescribed and follow up monitoring should be taken into account and balanced against the alternative of lifestyle changes.
• Effective, supported long term lifestyle changes have the potential to improve individual health and wellbeing and can be aligned with a more sustainable approach to healthcare. For example, supporting patients to reduce meat intake and increase physical activity by active transport (walking or cycling instead of driving) have the potential to benefit the individual’s health and wellbeing, reduce carbon footprint and reduce local air pollution (through less driving) in addition to reducing reliance on healthcare services.   

Join the conversation and take action:

1. Stay informed: Learn more about the NICE draft guideline and its potential impact on CVD risk assessment and reduction at https://www.nice.org.uk/guidance/indevelopment/gid-ng10178
2. Join the conversation: Share your thoughts and opinions on the importance of lifestyle changes and sustainable healthcare on social media using the hashtag #CVDriskreduction, tagging @SusHealthcare, and linking to this post.
3. Take action: Visit our website for more information and resources on sustainability in healthcare, and get involved by attending one of our courses in sustainability, health and healthcare.