I totally agree with using lifetime risk to assess the need for treatment. I always used to follow JBS2 guidelines treating to cholesterol targets of 4 and 2 (after deciding the need for treatment).
If the patient had what looked like high risk factors but did not reach treatment thresholds, I would put their age in the calculator as 65 (even if they were younger) to assess their 10-year risk to age 75 and treat accordingly.
I could never see the point of starting treatment after patients' arteries were already furred up.
Sadly, now for financial reasons we are using the NICE guidelines, but I do not think we are doing our patients any favours by doing so.
From Dr Lois Benjamin,
Enfield, Middlesex
