Cardiovascular medicine
Population implications of lipid lowering for prevention of
coronary heart disease: data from the 1995 Scottish health survey
I U Haqa, L E Ramsaya, E J Wallisa, C G Islesb, L D Ritchiec, P R Jacksona
a Section
of Clinical Pharmacology and Therapeutics, Department of Medicine and
Pharmacology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, b Department of Medicine, Dumfries and
Galloway Royal Infirmary, Bankend Road, Dumfries DG1 4AP, UK, c Department of General Practice
and Primary Care, University of Aberdeen, Forester Hill Health Centre,
Westburn Road, Aberdeen AB25 2AY, UK
Correspondence to: Professor Ramsay D.Colley{at}Sheffield.ac.uk
Accepted 9 May 2001
OBJECTIVE
To determine the
proportion of the population, firstly, with cholesterol
5.0 mmol/l and, secondly, with any cholesterol concentration, who
might benefit from statin treatment for the following: secondary
prevention of coronary heart disease (CHD); primary prevention at CHD
risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention at
projected CHD risk 20% over 10 years (CHD risk at age 60 years if
actual age < 60 years).
SUBJECTSRandom stratified sample of
3963 subjects aged 35-64 years from the Scottish health survey 1995.
RESULTSFor secondary prevention
7.8% (95% confidence interval (CI) 6.9% to 8.6%) of the population
with cholesterol 5.0 mmol/l would benefit from statins. For
primary prevention, the prevalence of people at CHD risk 30%, 20%,
15%, and 6% over 10 years is 1.5% (95% CI 1.2% to 1.9%), 5.4%
(95% CI 4.7% to 6.1%), 9.7% (95% CI 8.8% to 10.6%), and 32.9%
(95% CI 31.5% to 34.4%), respectively. At projected CHD risk 20%
over 10 years, 12.4% (95% CI 11.4% to 13.5%) would be treated with
statins. Removing the 5.0 mmol/l cholesterol threshold makes little
difference to population prevalence at high CHD risk.
CONCLUSIONSStatin treatment would be
required for 7.8% of the population for secondary prevention. For
primary prevention, among other factors, guidelines should take into
account the number of patients needing treatment at different levels of
CHD risk when choosing the CHD risk to target. The analysis supports a
policy of targeting treatment at CHD risk 30% over 10 years as a
minimum, as recommended in current British guidelines, with a move to
treating at CHD risk 15% over 10 years as resources permit.
Keywords: statins; coronary risk; secondary prevention; primary prevention
© 2001 by Heart
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This article has been cited by other articles:
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