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Radical overhaul for managing heart risk

Major changes are planned to BNF risk charts as concerns are raised over diuretics and statins – Rob Finch reports

Stringent new cholesterol targets are to be announced as part of a radical overhaul of risk management in cardiovascular disease.

New 'gold standard' guidelines from the Joint British Societies – expected to be reflected in changes to the BNF cardiac risk charts – will vastly increase the number of patients eligible for treatment.

Dr John Reckless, chair of Heart UK, said the change meant any patient who currently fell into the amber portion of the BNF risk charts would now fall into the red group eligible for immediate treatment.

British Cardiac Society chair Professor David Wood revealed the updated guidelines at the society's annual meeting last week.

He told delegates that rather than limiting assessment to risk of coronary heart disease, the guidance will advise GPs to target patients with a 10-year cardiovascular disease risk of 20 per cent for primary preventive treatment including statins.

The new lipid targets will set a more exacting standard than the one in the national service framework for coronary heart disease, with cholesterol at 4mmol/l and LDL cholesterol at 2mmol/l.

But in a concession to the new GP contract they will set an audit standard of 5mmol/l to match quality indicators.

The guidelines, due out this summer, also elevate diabetes to the status of an established cardiovascular disease that should be targeted for secondary preventive treatment.

The importance of more accurate assessment of lifetime risk will be stressed in a bid to ensure 'very high risk' young people are not undertreated.

Dr John Pittard, a member of the board of the Primary Care Cardiovascular Society and a GP in Staines, Middlesex, said the new guidelines were 'much simpler' and would focus on a multifactorial risk assessment. 'It means that on balance a person with type 2 diabetes has a big risk and shouldn't be excluded from treatment,' he said.

Proposed changes to the

joint societies' guidance

lRisk prediction charts, as published in the BNF, to be changed so red band (immediate medication for primary prevention recommended) covers anyone with a 10-year CVD risk of =20 per cent

lLipid treatment targets now 4mmol/l for total cholesterol (with 5mmol/l as the audit standard as per CHD 8 indicator in the Q&O framework) and 2mmol/l for LDL cholesterol

lDiabetes now a cardiovascular disease requiring secondary preventive treatment

lAdvice to be stressed on stopping smoking, eating healthily and taking physical exercise

lCriteria for using aspirin, ß-blockers, statins, ACE-inhibitors and warfarin to be 'refined'

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