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GPs warned not to chase CHD targets over cost fears

GPs have been issued with official guidance telling them not to chase aggressive cholesterol targets amid fears the costs would cripple the NHS.

The move – a dramatic U-turn over earlier draft guidance – is set to put national policy at direct odds with the influential Joint British Societies.

It will now become almost impossible for ministers to insist on tougher cholesterol targets for heart disease in the coming review of the quality and outcomes framework.

The new guidance recommends a cholesterol target of 5mmol/l for secondary prevention of CHD, on the grounds there is no evidence to back lower targets.

The recommendation only covers Scotland but it is likely NICE will follow suit later in the year under a 'memorandum of understanding'.

But although some GPs welcomed the advice, others angrily denounced it as putting costs ahead of clinical need.

The document from the Scottish Intercollegiate Guidelines Network (SIGN) admitted a target of 4mmol/l – as it had provisionally recommended – or even 4.5 mmol/l would have 'major resource implications'.

It follows two bulletins from the NHS in recent weeks urging GPs to stick to the 5mmol/l

target in a desperate attempt to control costs.

Professor Gordon Lowe, chair of SIGN, insisted the body had made its judgment on the basis of the evidence, as well as taking into account the 'vast' costs of lowering the target. 'There is no evidence to support reducing the current target of 5, which is in the QOF and generally used across the UK.'

Dr Rubin Minhas, a GP in Gillingham and member of the NICE lipid modification guideline group, said: 'I agree with what SIGN has done. Its recommendations represent safe, effective and evidence-based medicine. It supports the emerging perception that the JBS guidelines are too aggressive and too influenced by aggressively placing people on medication.'

But Dr George Kassianos, a GP in Bracknell, Berkshire, and PCT CHD lead, said: 'For secondary prevention I disagree with any target other than in JBS2. It is the patient's life at stake.'

Professor Peter Sever, a member of the JBS and professor of clinical pharmacology at Imperial College London, insisted the decision was based on cost.

Key guidance points

• Cholesterol target for secondary prevention to stay at 5 mmol/l

• Everyone over 40 should be assessed for risk of CHD and stroke at least every five years

• Lifestyle advice should be given during assessments

• People with a 20 per cent or higher risk of CVD over 10 years should be considered for a statin and low-dose aspirin

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