Table 2

Joint British Societies recommendations on lifestyle, risk factor, and therapeutic targets in patients with established coronary heart disease (CHD), or other atherosclerotic disease, and healthy individuals at high multifactorial risk. Reproduced from the summary of the Joint British recommendations on prevention of coronary heart disease in clinical practice,8 with permission of the BMJ Publishing Group

Patients with CHD or other atherosclerotic diseasePeople without overt CHD or atherosclerotic disease at high risk (absolute CHD risk ≥15% over 10 years)
*If resources do not permit drug treatment at 15% then 30% is the minimum acceptable.
ACE, angiotensin converting enzyme; EF, ejection fraction; HbA1c, glycated haemoglobin; LDL, low density lipoprotein.
Lifestyle targets for all patients
Stop smoking, make healthier food choices, increase aerobic exercise, and moderate alcohol consumption
Body mass index <25 kg/m2 is desirable, with no central obesity
Targets for other risk factors
Blood pressure < 140 mm Hg systolic and < 85 mm Hg diastolic
  • All patients to have blood pressure reduced to consistently < 140/85 mm Hg

Healthy individuals with
  • Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg: lifestyle advice and drug treatment if blood pressure is sustained at these levels on repeat measurements regardless of absolute CHD risk

  • Systolic blood pressure 140–159 mm Hg or diastolic blood pressure 90–99 mm Hg:

CHD risk ≥15% or target organ damage: Lifestyle advice and drug treatment if blood pressure is sustained at these levels on repeat measurementsIf CHD risk <15% and no target organ damage: Lifestyle advice and reassess annual
  • Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg:

Lifestyle advice and reassess in 5 years
Total cholesterol <5.0 mmol/l (LDL cholesterol <3.0 mmol/l)
  • All patients to have total cholesterol reduced to consistently below 5.0 mmol/l (LDL cholesterol <3.0 mmol/l)

Healthy individuals with
  • Familial hypercholesterolaemia or other inherited dyslipidaemia: Lifestyle advice and drug treatment

  • Total cholesterol >5.0 mmol/l:

CHD risk ≥15%: Lifestyle advices and drug treatment* if cholesterol sustained on repeat measurementsIf CHD risk <15%: Lifestyle advice; reassess annually if risk is close to 15%
Patients with diabetes mellitus
Total cholesterol <5.0 mmol/l (LDL cholesterol <3.0 mmol/l)
Blood pressure <130 mm Hg systolic and <80 mm Hg diastolic (<125 mm Hg systolic and <75 mm Hg diastolic when there is proteinuria)
Optimal glycaemic control: HbA1c <7%
Cardioprotective drug treatment
  • Aspirin for all patients

  • β Blockers at doses prescribed in clinical trials after myocardial infarction, particularly in high risk coronary patients and for at least 3 years

  • Cholesterol lowering agents (statins) at doses prescribed in clinical trials

  • ACE inhibitors at doses prescribed in clinical trials for patients with symptoms or signs of heart failure at time of myocardial infarction, or in those with persistent left ventricular systolic dysfunction (EF <40%)

  • Anticoagulants for patients at risk of systemic embolisation with large anterior infarctions, severe heart failure, left ventricular aneurysm, or paroxysmal tachyarrhythmias

  • Aspirin (75 mg daily) in individuals aged >50 years whose hypertension, if present, is controlled

Screening of first degree relatives
  • Screening of first degree blood relatives (principally siblings and offspring aged 18 years or older) of patients with premature CHD (men <55 years and women <64 years) or other atherosclerotic disease is encouraged and in the context of familial dyslipidaemias is essential

  • Screen close relatives if familial hypercholesterolaemia or other inherited dyslipidaemia is suspected