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Methods for the prediction of coronary heart disease risk
  2. H PRAIS
  1. Department of Medicine
  2. Manchester Royal Infirmary
  3. Oxford Road
  4. Manchester M13 9WL
  5. UK

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It is indisputable that patients with coronary heart disease (CHD) should generally receive statin treatment, certainly if their serum cholesterol exceeds 5 mmol/l.1 Patients with peripheral arterial disease or stroke are at a similar level of risk of a subsequent CHD event as are the survivors of myocardial infarction and are also increasingly recommended to receive statin treatment.2

Coronary risk in primary prevention

How to use statins in the primary prevention of CHD, however, remains controversial. The difficulty is not a lack of evidence of the clinical effectiveness of statins in primary prevention; this was established in the West of Scotland coronary prevention study3 and the Air Force/Texas coronary atherosclerosis prevention study.4 Rather it is that there are so many people who could benefit from statin treatment, particularly in Britain, which internationally has one of the worst records for CHD deaths. The cost of treating all those who can benefit would be enormous and require major adjustments to the use of other less cost effective treatment, if it were to be accommodated within the existing National Health Service (NHS) budget. Thus, while the scientific evidence of benefit for statin treatment extends to people with a 10 year CHD risk of less than 10%,4 the NHS framework on CHD prevention recommends the use of statins in primary prevention only when the CHD risk reaches 30% over 10 years.5 The Joint British Societies (British Cardiac …

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