A 64-year-old man who had a myocardial infarction six months ago presents for review.
What should his target cholesterol levels be?
1.Total cholesterol <3.5mmol/l ;LDL<1.5mmol/l
2.Total Cholesterol < 4.0 mmol/l; LDL<2.0MMOL/L
3.Total Cholesterol: HDL radio<5.0mmol/l
4.Total cholesterol: HDL ratio<4.0mmol/l
5.Total cholesterol <mmol/l LDL<3.0mmol/l
A systematic strategy should be used to identify people aged 40-74 who are likely to be at high risk of cardiovascular disease (CVD), defined as a 10-year risk of 20% or greater.
Joint British Society 2 (JBS2)
ASSIGN (Scotland only)
The 1991 Framingham equations may still be used. It is however recommended that adjustments are made in the following situations:
first-degree relative with a history of premature coronary heart disease (defined as < 55 years in males and < 65 years in females) - increase risk by 1.5 times if one relative affected or up to 2.0 times if more than one relative affected
males of South Asian ethnicity - increase risk by 1.4 times
Along with lifestyle changes drug treatment should be considered for patients with a 10-year CVD risk of 20% or greater
simvastatin 40mg on is the first line treatment
there is no target level for total or LDL cholesterol for primary prevention
liver function tests should be check at baseline, within 3 months and at 12 months but not again unless clinically indicated
All patients with CVD should be taking a statin in the absence of any contraindication
Increase simvastatin to 80mg if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained.