NICE's simplified approach to lipids will not work

doi:10.1136/bmj.39605.513889.3A

BMJ 2008;336:1324 (14 June), doi:10.1136/bmj.39605.513889.3A

Letters

NICE on lipid modification

NICE’s simplified approach to lipids will not work

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

Although starting all patients on simvastatin 40 mg for secondaryprevention is a sound approach for many,¹ a substantial proportionwill not achieve the targets of less than 4 mmol/l for totalcholesterol and 2 mmol/l for low density lipoprotein (LDL) cholesterolwith this therapy.

A meta-analysis by Law et al in 2003 showed that simvastatin40 mg achieves a reduction in LDL cholesterol of 37%.² Thisimplies that as initial therapy, any patient with an LDL measurementhigher than 3.1 mmol/l would not be treated to target with simvastatin40 mg. In the same study, simvastatin 80 mg achieved a 42% reductionin LDL; atorvastatin 40 mg and rosuvastatin 20 mg achieved reductionsof 49% and 48%, respectively.

Starting patients with an LDL of greater than 3.1 mmol/l onsimvastatin 40 mg seems to mean that their treatment will inevitablyhave to be escalated at a later date. This . . . [Full text of this article]

Stuart J Laurie, general practitioner

¹ Long Lane Medical Centre, Liverpool L9 6DQ

stuart.laurie@livgp.nhs.uk

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