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GPs go forth

High-dose statins only for highest risk

Intensive statin treatment is

only worth it very high risk patients, a new study concludes.

The meta-analysis found use of high-dose statins did cut all-cause mortality in patients with recent acute coronary syndrome, but not in those with stable coronary heart disease.

The findings appear to back moves to treat wider groups

of patients with lower doses, rather than ramping up

treatment in CHD patients.

The research, published online by Heart, pooled six trials covering 110,038 patient-years. In patients with recent acute coronary syndrome, intensive statin therapy – 80mg simvastatin or equivalent – reduced all-cause mortality from 4.6 to 3.5 per cent over two years. But in patients with stable CHD, intensive therapy had no effect on mortality over 4.7 years.

Lead author Dr Jonathan Afilalo, associate professor of medicine at McGill University in Montreal, Canada, said: 'Intensive statin therapy should be recommended after recent acute coronary syndrome but considered on a case-by-case basis in stable CHD.'

Dr John Pittard, a GP in Staines, Middlesex, and member of the CHD national service framework guidance group, backed the findings. 'If you have a high-risk patient, treat intensively at 4mmol/l and 2mmol/l. With moderate-risk patients, treat a high proportion. Chasing low- to moderate-risk patients generates a lot of heat.'

Dr Peter Randall, a GP in Sandown and former CHD lead for Isle Of Wight PCT, said: 'GPs are now recognising acute coronary syndrome as an important diagnosis.'

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