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Cholesterol confusion

Your reporting of the recent NICE lipid guideline refers to a target of total and LDL cholesterol of 4 and 2mmol/l respectively. This is incorrect.

It is spelt out in the guideline that 'a target for total cholesterol or LDL cholesterol is not recommended for people with established CVD who are treated with a statin'.The point of this is to focus those with high cholesterol and not be too distracted by people with a cholesterol near 4mmol/l.

Many will never reach targets of 4 and 2 no matter how many drugs they are on, and the vast majority of the benefit gained from taking statins is gained with that first treatment of simvastatin 40mg.

Also, the targets move due to day-to-day variation of cholesterol levels and random variation of lab analysers. There is nothing to stop us advising patients to take more potent statin preparations if they are at very high risk and can tolerate the increased side-effects, but target-chasing for its own sake should be avoided.

From Dr Peter Brindle, Bristol

• Editor's note

We used 'target' as shorthand, but were careful to say NICE also allowed for an audit target of 5mmol/l, in line with the QOF.

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