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Managing dyslipidaemia for the primary prevention of cardiovascular disease

BMJ 2018; 360 doi: (Published 23 March 2018) Cite this as: BMJ 2018;360:k946

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Dyslipidaemia or cardiovascular risk?

Ryan et al explains that lipid levels contribute little to cardiovascular risk in comparison to age, sex, diabetic status, smoking status and a number of other risk factors. He points out that cardiovascular risk is a better predictor of benefit than lipid measurements, and that treatment is informed by cardiovascular risk. (1) A high risk patient benefits significantly from statins irrespective of their lipid levels. Low risk patients benefits less from statins irrespective of their lipid levels. What does using the term dyslipidaemia add this context? Aside from a small minority with familial hyperlipidaemia, lipid levels contribute little to eligibility for treatment and contribute little to discussing risks and benefits of treatment with a patient. Historically the prevention of cardiovascular disease may have clustered around the control of specific risk factors. But surely this is an anachronism? Forty years have elapsed between publication of the first Framingham risk equation and QRisk3 and yet we still seem wedded to risk factors. (1,2) Perhaps this tells us more about the way we organise medical specialities than about epidemiology.

Tom Marshall

1. Ryan A, Heath S, Cook P. Managing dyslipidaemia for the primary prevention of cardiovascular disease. BMJ 2018;360 doi: 10.1136/bmj.k946
2. Kannel WB, et al. A general cardiovascular risk profile: the Framingham study. Am J Card 1976;38:46-51.
3. Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ 2017;357 doi: 10.1136/bmj.j2099

Competing interests: No competing interests

27 March 2018
Tom Marshall
Professor of Public Health & Primary Care
University of Birmingham
Edgbaston, Birmingham, B15 2TT