JBS2 is not the problem – its critics are
From Dr George Kassianos, Bracknell, Berkshire
Your report on the second Joint British Societies Guidelines on prevention of cardiovascular disease in clinical practice (JBS2) attempts to diminish the importance of JBS2 by calling them 'controversial' (News,
5 April). In fact, controversial are the critics of JBS2 because they have not understood what these guidelines are for and how they were put together.
JBS2 were developed by a working party with members taken from the following organisations: British Cardiovascular Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; The Stroke Association.
As you can see, primary and secondary care as well as patients were represented. All sections of the JBS2 document represent an evidence-based consensus by all professional societies involved. Being a consensus document, JBS2 was not concerned with grading of its recommendations. That is the job of NICE and SIGN.
JBS2 is a document that clearly and simply tells us, on the basis of current multiple evidence, what is best practice and how best to help our patients. The scientific literature that informs the
JBS2 recommendations is referenced throughout the document.
The aim of JBS2 is 'to promote a consistent multidisciplinary approach
to the management of
people with established atherosclerotic cardiovascular disease and those with high risk of developing symptomatic atherosclerotic disease'. This is stated right from the start of the JBS2 document.
Your report states that
since the release of JBS2, it
'has been mired in controversy over its ultra-low cholesterol targets'. In fact, what is controversial in my mind and that of many physicians, is
the relatively high levels of cholesterol currently recommended in the UK.
When treating a patient with established cardiovascular disease, I would be failing my patient if I was to keep his/her total cholesterol at 5mmol/l and LDL-C at 3mmol/l. I remember in the early 1990s, we were ignoring cholesterol levels until the 4S study was announced. From then on, we realised the importance of lowering cholesterol. We now have increasingly a number of studies available showing that provided we reduce LDL cholesterol to low levels, such as 2mmol/l or below (the JBS2 recommendation), in patients with established and symptomatic atherosclerotic disease, we can reduce, halt, or even reverse the process of atherosclerosis. A LDL-C level
of 2mmol/l or below in a patient with established atherosclerotic disease is not an 'ultra-low cholesterol target' but a clinical must.
The JBS2 document is an excellent practical guide
and reflects best practice.
It plays a different role to
NICE and SIGN. It is good practice for the patient and I do wholeheartedly recommend it.