BMJ  2008;336:1248-1249 (31 May), doi:10.1136/bmj.39580.424352.AD

Practice

Commentary: Controversies in NICE guidance on lipid modification for the prevention of cardiovascular disease

¹ Clinical Sciences Research Institute, University of Warwick Medical School, Coventry CV2 2DX

doi: 10.1136/bmj.39554.624086.AD

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

The new guidelines from the National Institute for Health and Clinical Excellence (NICE) on lipid modification for the prevention of cardiovascular disease will guide the way we assess cardiovascular risk and treat lipids, both in primary and in secondary care. What are the new aspects, and what is it that might spark controversy in this new publication?

To identify those requiring primary prevention of cardiovascular disease, the guideline reaffirms the threshold of a 10 year cardiovascular disease risk >20% in people aged over 40 years. Its recommendation of a systematic, rather than opportunistic, risk assessment is welcome, particularly in primary care. The new guidelines wisely reaffirm the 1991 Framingham risk score as the score of choice for guiding primary prevention.

However, they also retain subjective, non evidence-based adjustments. They advise increasing the risk estimate by 1.5-2.0 in the presence of premature family history and by 1.4 in South Asian men, . . . [Full text of this article]

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