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At the heart of general practice since 1960

GP slashes CVD mortality by 80%

By Nigel Praities

Aggressive treatment of cardiovascular risk factors in general practice can produce dramatic reductions in mortality, according to an audit of GP records spanning over a quarter of a century.

A crusading practice in Sheffield – which has been screening for cardiovascular risk since 1990 and intensively treating blood pressure and cholesterol levels for even longer – has reported huge reductions in deaths from heart disease or strokes.

Deaths from cardiovascular causes in the under 70s plummeted by 79% between 1981 and 2007. And overall mortality in the same group dropped by 32%, providing evidence that aggressive cardiovascular treatment does more than simply change the cause of death.

Dr John Revill, a GP in Sheffield, adopted extensive use of statins and ACE inhibitors from 1989 and started working to total and LDL cholesterol targets of 4 and 2mmol/l as early as 1990 - much to the chagrin of his local health authority.

Dr Revill told delegates at the Heart UK annual conference in Hertfordshire late last month, that he his approach and repeatedly brought him into conflict with local NHS managers. ‘I have been quoted as the most expensive GP in Sheffield, prescribing the largest amount of statins by a long way in my city. I took a risk, but I felt I could not wait with such good drugs around,' he said.

Mortality for ischaemic heart disease and stroke was reduced by 42% across his practice list from 1981 to 2007, and over half in those aged 70 to 79 years.

Dr Revill's presentation was lauded by colleagues at the conference. Dr John Reckless, board member of Heart UK and consultant endocrinologist at the University of Bath, said the striking effect on outcomes had vindicated Dr Revill's treatment approach. ‘I congratulate you on withstanding the abuse and bullying I know you suffered from your health authority for this "overtreatment" of blood pressure and lipids,' he said.

Dr Jim Kennedy, RCGP prescribing spokesman, said the data demonstrated how the benefits of many interventions, especially for cardiovascular disease, were only seen long-term. ‘People have got to stop just concentrating on individual budgets and start looking at the costs to the system overall. When PCTs look at a prescribing budget, they start to lay eggs over it, but they need to look at the long-term cost,' he said.

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