Exclusive: Tougher targets forecast for CVD

Tougher cholesterol targets could be included in the quality framework in three years' time, an expert who helped write the Joint British Societies (JBS2) guidelines has said.

JBS2 targets for total cholesterol of 4mmol/l and LDL cholesterol of 2mmol/l are aspirational, said Dr Vinod Patel, a reader in clinical skills at Warwick University and member of Diabetes UK.

But when the patent on atorvastatin (Lipitor) runs out, it might be cost-effective to achieve these targets in patients who are at high risk of having a cardiovascular event, he said.

'We can't afford it, but just because we can't afford it doesn't mean we shouldn't aim for it,' said Dr Patel.

The call coincides with publication of draft NICE guidelines on lipid control, which advocate the JBS2 targets for those with established cardiovascular disease (CVD). NICE does not stipulate cholesterol targets for primary prevention of CVD, however.

JBS2 is tougher than current quality targets to reduce total cholesterol to 5mmol/l and LDL cholesterol to 3mmol/l.

NICE maintains that first-line treatment should be simvastatin or pravastatin 40mg daily, with a lower dose or alternative statin to be prescribed if dictated by clinical need or tolerability.

Dr Patel said: 'I think the 4mmol/l and 2mmol/l targets should be there for people for secondary prevention.

'I don't think you need it for everyone because of affordability. But in three years' time it might be an option.'

Professor David Wood, chairman of the JBS2 guidelines and a member of the NICE guideline development group (GDG), said: 'The NICE GDG takes the view that there shouldn't be a cholesterol threshold for primary prevention. But the JBS2 takes the view that the distinction between primary and secondary prevention is arbitrary.'

DoH heart disease czar Professor Roger Boyle reiterated his view that JBS2 cholesterol targets would not become national policy.

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