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CAMHS won't see you now

Experts urge GPs to consider statins from the age of 18

By Nerys Hairon

GPs should quiz all patients aged 18 or over about their family history under new guidelines on assessing eligibility for statins, Pulse understands.

The eagerly-awaited Joint British Societies guidelines, which will finally be released next week a year overdue, will urge GPs to consider statins in patients as young as 18 ­ if they have major risk factors.

GPs protested that the recommendations would mean screening far in excess of half the entire population. They demanded extra resources to cope with the spiralling workload.

The new guidelines, due to be published in Heart and circulated to practices next week, recommend GPs consider stat-ins for those aged 18 to 39 with high-risk family history, retinal disease, the metabolic syndrome and a series of other risk factors (see box, above).

GPs are advised to formally assess all patients over the age of 40 for their risk of cardiovascular disease and treat those with a 10-year CVD risk of 20 per cent or higher.

Professor Mike Kirby, a member of the Joint British Societies and a GP in Letchworth, Hertfordshire, said: 'At the moment GPs are completely flat out and [the extra work] will be a lot of patients.

'Extra work either needs to come as an enhanced service or as part of QOF.'

Dr Rubin Minhas, CHD lead at Medway PCT and a GP in Kent, said: 'There is little firm evidence to support treating some of the patients who have been suggested in the 18 to 39 group.'

He added that the guidelines would mean assessing 28 million people aged over 40. 'This does not seem to be realistic given the current resources in the NHS.'

Dr John Ashcroft, CHD lead at Erewash PCT and a GP in Ilkeston, Derbyshire, said the guidelines would mean a 'lot of work, and probably little to show for it', and could make health inequalities worse.

He said it would be difficult to identify patients with a high-risk family history without trawling through the whole population, and finding those with the metabolic syndrome might mean treating the worried well.

Main JBS recommendations

· Assess all patients over 40 for CVD risk

· Start statins at 20 per cent or higher 10-year risk of CVD

· Consider statins in all patients aged 18 to 39 with nephropathy, retinal disease, hypertension, high cholesterol, metabolic syndrome, high-risk family history and persistently uncontrolled diabetes

· Cholesterol target of 4mmol/l and LDL target of 2mmol/l for high-risk patients

· Audit standard of total cholesterol of 5mmol/l

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