BMJ 1998;317:1093-1094 ( 24 October )

Editorials

Assessing heart disease risk in primary care

Cholesterol lowering should be just one part of a multiple risk factor intervention

General practice pp   1120 -35  

The first 150 words of the full text of this article appear below.

Distilling evidence from randomised controlled trials and observational studies into valid and usable guidelines is not easy. Despite unequivocal evidence that lowering cholesterol concentrations reduces mortality from coronary heart disease,¹ producing guidelines on prevention that meet with universal agreement has proved difficult.² Four articles in this week's issue illuminate the difficulties.

Unwin et al show that the application of different cholesterol guidelines leads to considerable variations in decisions to screen and to treat when applied to a representative population (p 1125).³ This is not surprising when the content and recommendations of the cholesterol guidelines are studied (see their table 1). A previous study in the United States showed a similar magnitude of disagreement between older and newer versions of the US guidelines, Canadian guidelines, and a coronary risk model derived from Framingham data.⁴ In the US study the Framingham model proved to be the most accurate method to predict . . . [Full text of this article]

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Relevant Articles

Preventing ischaemic heart disease in one general practice: from one patient, through clinical audit, needs assessment, and commissioning into quality improvement • Commentary: Clinical and economic perspectives have to be integrated when selecting priorities for intervention

Mike Pringle and Jeremy Jones
BMJ 1998 317: 1120-1124. [Full Text] [PDF]

Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors

Nigel Unwin, Richard Thomson, Ann Marie O'Byrne, Mike Laker, and Heather Armstrong
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From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia

Karen Fairhurst and Guro Huby
BMJ 1998 317: 1130-1134. [Abstract] [Full Text] [PDF]

Time trend analysis and variations in prescribing lipid lowering drugs in general practice

Catherine Baxter, Roger Jones, and Laura Corr
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This article has been cited by other articles:

• Cornell, S J, Chilcott, J B, Brennan, A (2001). Is it feasible to plan secondary care services for coronary heart disease rationally? A quantified modelling approach for a UK Health Authority. J. Epidemiol. Community Health 55: 521-527 [Abstract] [Full text]  
• Haq, I.U., Ramsay, L.E., Jackson, P.R., Wallis, E.J. (1999). Prediction of coronary risk for primary prevention of coronary heart disease: a comparison of methods. QJM 92: 379-385 [Abstract] [Full text]  

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