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Woolly cholesterol guidance from NICE leaves us in dark

I'm writing regarding your article on the new NICE lipid guidance.

Perhaps I'm missing something, but I do not read in the new NICE guidance that the total cholesterol target is 4mmol/l. The guidance actually states that treatment should be initiated with simvastatin 40mg, and increased to simvastatin 80mg or equivalent if 4mmol/l is not reached. It does not, however, go on to suggest that even higher-dose statins should be used until that level is reached. It accepts that up to 50% of patients may not reach 4mmol/l, and that the audit standard is 5mmol/l.

This, therefore, is a halfway house between the DH's previous position and the belief among cardiologists and industry in a meaningless target of 4mmol/l.

Ultimately, simvastatin 40-80mg will reduce total cholesterol by 25-30% in most patients irrespective of their initial cholesterol, and this will deliver the benefit seen in all major trials, again irrespective of initial or post-treatment levels. In my population of patients this approach leaves most with a total cholesterol of less than 4.4, but not 4.

Once again, poorly worded and woolly guidance leaves us open to unwanted and time-consuming debate.

From Dr Pete Budden, prescribing lead, Salford PCT

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