CARDIOVASCULAR RISK IN HYPERTENSION - IMPLICATIONS OF THE SHEFFIELD TABLE FOR LIPID-LOWERING STRATEGY

Objective: To determine the actual use of 'statin' therapy for primary and secondary prevention and the potential effect of using the Sheffi eld Table for primary prevention of coronary heart disease upon 'stati n' use in a consultant-run Hypertension and Cardiovascular Risk Clinic . Design: Prospective audit of the current use of cholesterol-lowering therapy and the effect of implementing the criteria used in the Sheff ield Table and the Scandinavian Simvastatin Study for cholesterol lowe ring in 'at risk' patients upon 'statin' use in a consultant-led cardi ovascular risk clinic, Setting: The Aberdeen Hypertension Clinic, Resu lts: A total of 1500 patients were reviewed of which 416 (27.7%) had e xperienced at least one clinical manifestation of atherosclerotic card iovascular disease (CVD) and 392 (94%) of these had a total cholestero l measured of whom 298 (76%) had a total cholesterol >5.5 mmol/l. Only 11.2% of eligible patients were actually receiving lipid-lowering tre atment for secondary prevention. A total of 1084 patients with no prio r cardiovascular disease were identified, 97 (8.9%) were excluded beca use of age. Using the Sheffield Table, 92 (9.4%) of these patients wer e eligible for statin therapy and only six of the 92 patients were act ually receiving treatment. Conclusions: The results of this study reve al that even in a consultant-led cardiovascular prevention clinic ther e is a significant discrepancy between optimal evidence-based manageme nt and the actual delivery of clinical care. Seventy-two per cent and 9.3% of patients attending the clinic were eligible for statin treatme nt for secondary and primary prevention, respectively. However, only 1 1.2% of patients suitable for secondary prevention and 6.5% of patient s suitable for primary prevention were actually receiving appropriate lipid-lowering therapy, Considering the proven benefit of this form of medical intervention the results of this study are of real importance to practising clinicians and patients alike.