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GPs face cholesterol target of 4mmol/l in all CHD patients

GPs will have tough new

cholesterol-lowering targets to meet under forthcoming national guidance on managing coronary heart disease.

The Joint British Societies' guidelines, due later this year, will recommend using statins and dietary advice to lower

total cholesterol levels to less than 4mmol/l and LDL-

cholesterol levels to below 2mmol/l in patients with

diagnosed CHD.

Current 1998 guidance from the Joint British Societies, echoed in the national service framework for CHD, requires patients at high risk of heart disease to have their cholesterol lowered to less than 5mmol/l and their LDL-

cholesterol to below 3mmol/l.

The revised guidelines will also recommend lowering cholesterol to the new target levels in patients with a cardiac event risk greater than 15 per cent over 10 years ­ half that of the previous guidance.

But primary care experts warned the move would make an unmet need 'even greater'.

Professor Francesco Cappuccio, professor of primary care research and development at St George's Hospital Medical School, London, said the targets were unrealistic.

He added: 'You have to work out the burden in primary care and how likely it is that the targets will be delivered with the current budget and resource restrictions. Not even the previous targets were feasible. It could be making an unmet need even greater by moving the goalposts.'

Professor Cappuccio, who has carried out research into CHD risk, said the guidelines would have to take account of ethnic minorities.

He said the 15 per cent

cardiac event risk over 10 years was the equivalent of 12 per cent in Asians and 10 per cent in black patients.

Professor John Betteridge, professor of endocrinology and metabolism at University College London, said the revised guidelines took account of the very latest evidence.

Professor Betteridge, a mem- ber of the guidelines committee, said: 'The move towards lowering cholesterol will bring us in line with the evidence. They already do it in the States.'

Dr John Pittard, a GP in Staines, Middlesex, and a member of the CHD national service framework's external reference group, said: 'To me it's worth it. If you set the cholesterol target to 4 and 2 then more GPs will be able to lower it to 5 and 3.

'This means more GPs will increase the statin dose and use combination drugs.'

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