9 Which asymptomatic hypercholesterolaemic
patients benefit from lipid-lowering therapy? What
cholesterol level should I aim for?
John Betteridge
Recently two major primary prevention trials with statins,
WOSCOPS^1 in hypercholesterolaemic men and AFCAPS/TEX-
CAPS^2 in healthy men and women with average cholesterol and
below average HDL cholesterol, have demonstrated highly signif-
icant reductions in CHD events. Although benefit extends to those
at low absolute risk of an event it is sensible to reserve pharmaco-
logical therapy for those at highest risk. Recent joint recommenda-
tions of the British Cardiac Society, British Hyperlipidaemia
Association and British Hypertension Society^3 suggest treatment
(as a minimum) for an absolute risk of 30% or greater over
10 years with the ultimate objective of treating those with risk
exceeding 15%. Goals of therapy are total cholesterol less than
5.0mmol/l (LDL-cholesterol <3.0mmol/l). Risk charts based on
the Framingham prospective population data taking into account
blood pressure, age, smoking status, diabetes and total cholesterol
to HDL ratio are provided. These charts do not apply to
individuals with severe hypertension, familial dyslipidaemia or
diabetic patients with associated target organ damage who should
receive statin therapy.
RReeffeerreenncceess
1 Shepherd J, Cobbe SM, Ford I et al.for the West of Scotland Coronary
Prevention Study Group. Prevention of coronary heart disease with
pravastatin in men with hypercholesterolaemia. N Engl J Med1995;
333333 : 1301–7.
2 Downs GR, Clearfield M, Weiss S et al. Primary prevention of acute
coronary events with lovastatin in men and women with average
cholesterol levels: results of AFCAPS/TEXCAPS. Air Force/Texas
coronary atherosclerosis study. JAMA1998; 227799 : 1615–22.
3 Joint British recommendations on prevention of coronary heart disease
in clinical practice. British Cardiac Society, British Hyperlipidaemia
Association, British Hypertension Society endorsed by the British
Diabetic Association. Heart 1998; 8800 ((ssuuppppll 22 )): S1–S29.