Quality statement 7: Side effects of high‑intensity statins

Quality statement

Adults on a high‑intensity statin who have side effects are offered a lower dose or an alternative statin.

Rationale

The use of high‑intensity statins can cause side effects, but to improve clinical outcomes it is important that alternative strategies are tried rather than stopping treatment. Any statin at any dose reduces the risk of cardiovascular disease (CVD).

Quality measures

Structure

Evidence of local arrangements to ensure that adults on a high‑intensity statin are monitored for side effects and offered a lower dose or an alternative statin if necessary.

Data source: Local data collection.

Process

Proportion of adults reporting side effects from a high‑intensity statin who are given a lower dose or alternative statin.

Numerator – the number in the denominator at which a lower dose or alternative statin is prescribed.

Denominator – the number of presentations of adults reporting side effects from a high‑intensity statin.

Data source: Local data collection.

Outcome

Adherence to statin therapy.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (primary care and secondary care) should ensure that adults on a high‑intensity statin who have side effects are offered a lower dose or an alternative statin. Service providers should see recommendation 1.3.42 in NICE's guideline on lipid modification for further information.

Healthcare professionals offer a lower dose or an alternative statin to adults who have side effects from a high‑intensity statin.

Commissioners (NHS England area teams and clinical commissioning groups) should ensure that providers are aware that adults on a high‑intensity statin who have side effects should be offered a lower dose or an alternative statin.

What the quality statement means for patients, service users and carers

Adults taking a statin who have side effects are offered a lower dose or a different type of statin.

Source guidance

Definitions of terms used in this quality statement

High‑intensity statin

The intensity of a statin is defined based on the percentage reduction in low‑density lipoprotein (LDL) cholesterol it can produce. A high‑intensity statin can produce a reduction above 40%. High‑intensity statins include:

  • atorvastatin 20 mg to 80 mg

  • rosuvastatin 10 mg to 40 mg

  • simvastatin 80 mg. [Lipid modification (NICE guideline CG181)]