MI targets 'not tough enough'

The updated NICE recommendations for the secondary prevention of MI should recommend lower target levels for cholesterol and LDL, according to a member of the Primary Care Cardiovascular Society (PCCS).

West London GP Dr Sarah Jarvis, a PCCS member, said that the guidance published this week had stuck with recommendations for cholesterol and LDL targets of 5mmol/l and 3mmol/l respectively, despite evidence suggesting that high-risk post MI patients should be given aggressive cholesterol management.

'In the US, they recommend an optional target of below 1.8mmol/l for LDL in high-risk MI patients, while in the rest of Europe they have been recommending 4.5mmol/l for cholesterol and 2.5mmol/l for LDL since 2003,' said Dr Jarvis.

It is not good enough for NICE to hide behind the excuse that it will be issuing a separate determination on cholesterol levels in its technology appraisal some time after December 2007, she said.

But Dr Jarvis welcomed the guidance recommendations on lifestyle, such as giving up smoking, performing 20-30 minutes of exercise a day and eating a Mediterranean diet. The guidance is for England and Wales.

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