Cholesterol as a statin indication

Paul Durrington, Professor of Medicine,
July 11, 2013

This article contains some valuable information, but is misleading in at least one important respect. The Joint British Societies did not recommend statin treatment when cholesterol levels are higher than 6mmol/l. Rather, they recommended that a ratio of total serum cholesterol to HDL cholesterol exceeding 6 should be an indcation. This is actually the most conservative use of lipid values as arbiters of who should receive statin treatment. NICE and the the European Society of Cardiology/European Atherosclerosis Society both recommend serum total cholesterol levels of 8mmol/l or more for a statin regardless of cardiovascular risk. Because HDL would have to be less than 1.33 mmol/l to have a total to HDL cholesterol ratio of more than 6 when total cholesterol is 8 mmol/l, far fewer people will receive a statin if the Joint British Guidelines are followed. The whole business of using total cholesterol as a statin indication is ridiculous, because a woman whose HDL cholesterol is 2 mmol/l and whose total cholesterol is 8 mmol/l would receive a statin even though she is actually at low risk.

Conflict of Interest:

I was an author of the Joint British Societies' Guidelines

Conflict of Interest

None declared