GPs should avoid prescribing high dose simvastatin to patients with cardiovascular disease (CVD), after latest research found that the 80mg dose of the drug could increase the risk of myopathy.

Current NICE lipid modification guidance recommends that GPs use 80mg simvastatin to achieve targets of 4mmol/l for total cholesterol and 2mmol/l for LDL cholesterol for the secondary prevention of CVD.

But the findings of the SEARCH trial, presented at the annual American Heart Association scientific sessions in New Orleans this week, found little evidence to back up NICE.

The trial involved 23,365 patients who were randomly assigned to receive either 20mg of simvastatin daily or the higher dose of 80mg daily, for an average follow-up of 6.7 years.

Overall, the researchers found that high-dose simvastatin produced only a small additional reduction in LDL cholesterol of 0.35mmol/l compared with the 20mg dose, but increased the risk of side-effects.

Lead researcher Professor Jane Armitage, from the University of Oxford, said: 'In SEARCH we did see more myopathy, 53 cases, in the 80mg group than in the 20mg group, where there were three cases.'

Berkshire GP Dr George Kassianos, a member of the British Cardiovascular Society, said that there was no place for the use of simvastatin 80mg in primary care.

'The NICE guidance is based on cost not evidence. This trial shows that 80mg simvastatin produces a very small reduction in LDL cholesterol.

'The NICE guidance may prove dangerous as the incidence of myopathy with the 80mg dose was high in this trial.'

GPs should move patients from 20mg simvastatin onto 10mg of rosuvastatin instead of titrating up the dose of simvastatin, advised Dr Kassianos.

sanjay.tanday@haymarket.com

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