Elsevier

The Lancet

Volume 346, Issue 8988, 2 December 1995, Pages 1467-1471
The Lancet

Sheffield risk and treatment table for cholesterol lowering for primary prevention of coronary heart disease

https://doi.org/10.1016/S0140-6736(95)92477-9Get rights and content

Abstract

Summary

When used for the secondary prevention of coronary heart disease, treatment with an inhibitor of hydroxymethylglutaryl-coenzyme-A reductase results in worthwhile benefit that clearly exceeds any risk in patients whose risk of coronary death is 1·5% or more per year. This evidence can be extrapolated logically to primary prevention of coronary disease provided that treatment is targeted at those with similar or higher risk.

We present a table that refines previously proposed methods of risk prediction. The table identifies subjects who have the specified degree of coronary risk; shows the serum cholesterol concentration that confers that degree of risk in the individual; and identifies subjects who will not have this degree of risk, irrespective of their cholesterol concentration. It is simple enough for use in ordinary practice. The table highlights the predominant effect of age on coronary risk; a person who is free of vascular disease and younger than 52 years is unlikely to have the specified degree of risk. Even in older people (60-70 years) several risk factors are generally required to attain this degree of risk. Some people are candidates for lipid-lowering drug treatment with serum cholesterol as low as 5·5 mmol/L, whereas others with cholesterol as high as 9·0 mmol/L are not.

Although cholesterol lowering is a powerful method for preventing coronary events in people at high risk, cholesterol measurement by itself is not a good way to identify those with high coronary risk. The method can be adapted readily to target a different level of coronary risk as new evidence on the benefit and risk of treatment becomes available.

References (31)

  • I. Holme

    An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence

    Circulation

    (1990)
  • G. Davey Smith et al.

    Cholesterol lowering and mortality: the importance of considering initial level of risk

    BMJ

    (1993)
  • M. Oliver et al.

    Lower patient's cholesterol now

    BMJ

    (1995)
  • Se Andrade et al.

    Discontinuation of antihyperlipidaemic drugs-do rates reported in clinical trials reflect rates in primary care settings?

    N Engl J Med

    (1995)
  • UK-TIA Study Group

    The UK-TIA Aspirin Trial: the interim results

    BMJ

    (1988)
  • Cited by (136)

    • Accelerated atherosclerosis and cardiovascular disease in systemic lupus erythematosus

      2021, Revista Colombiana de Reumatologia
      Citation Excerpt :

      For the general population, most risk stratification tools are based on levels of well-established CVRFs such as the Framingham risk score.88 Other examples are the Reynolds score89 which includes high-sensitivity CRP, the Sheffield table system,90 and the SCORE system in Europe. These different methods are similar in their overall low sensitivity and specificity for development of CVD as they exclude various emerging, genetic and otherwise unknown risk factors.

    • Atherosclerosis in systemic lupus erythematosus

      2017, Best Practice and Research: Clinical Rheumatology
      Citation Excerpt :

      For the general population, the main risk stratification tools are based on levels of well-established CVD risk factors such as age, sex, serum cholesterol, smoking and blood pressure. The Framingham risk score [31] is the most widely used, but others have also been developed, for example, the Reynolds score [32], which includes high-sensitivity C Reactive Protein (hsCRP) and the Sheffield table system [33]. These different methods are similar in their overall low sensitivity and specificity for development of CVD as they exclude various emerging, genetic and otherwise unknown risk factors.

    • The Framingham Heart Study's Impact on Global Risk Assessment

      2010, Progress in Cardiovascular Diseases
      Citation Excerpt :

      The Sheffield risk tables used in the United Kingdom are derived from the Framingham population. For people without a history of CVD, the table presented in Haq et al40 (1995) shows each combination of age, sex, tobacco smoking status, hypertension, history of diabetes, and LVH on electrocardiogram for which there is a total cholesterol level that confers a 1.5% or greater risk of having a fatal coronary event within 1 year. These are the patients who are predicted to most benefit from statin treatment.

    View all citing articles on Scopus
    View full text