The gap between policy and reality is large in the UK

Papers p 1322

Standards three and four of the NHS's National Service Framework for Coronary Heart Disease require primary care teams to identify and modify risk factors in patients who have a greater than 30% risk of developing heart disease over 10 years; they must also offer advice and treatment to all patients with established coronary artery disease to help them reduce their risks.1 Yet the study published by Primatesta and Poulter this week (p 1322) found that less than one third of patients in England who have a history of coronary heart disease or stroke receive lipid lowering treatment, and that recently recommended targets for cholesterol concentrations were reached by only about 1 in 10 of those who were eligible for treatment.2 Primatesta and Poulter's findings are in accordance with those of other studies.3^–5

Why are so few patients receiving lipid lowering treatment? The consensus that cholesterol is an important reversible risk factor for coronary heart disease was reached only comparatively recently as a result of studies published in 1994 and 1995. 6 7 In the United Kingdom, extra resources to fund this additional treatment have not been provided.

At the recent meeting of the European Society of Cardiology (Amsterdam, August 2000) unpublished data were …