Quality standard

Quality statement 7: Side effects of high‑intensity statins

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local protocols.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as primary care services and secondary care services) should ensure that adults on a high‑intensity statin who have side effects are offered a lower dose or an alternative statin.

Healthcare professionals (GPs, doctors in secondary care, nurse prescribers and pharmacists) offer a lower dose or an alternative statin to adults who have side effects from a high‑intensity statin.

Commissioners 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.

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

Definitions of terms used in this quality statement

Alternative statin

A different statin in the same intensity group (rosuvastatin if already receiving atorvastatin) or changing the statin to a lower intensity group. [NICE's guideline on cardiovascular disease, recommendation 1.9.2]

High-intensity statin

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

  • atorvastatin 20 mg to 80 mg

  • rosuvastatin 10 mg to 40 mg.

[NICE's guideline on cardiovascular disease, terms used in this guideline]