Population implications of lipid lowering for prevention of coronary heartdisease: data from the 1995 Scottish Health Survey

Objective-To determine the proportion of the population, firstly, with chol esterol greater than or equal to 5.0 mmol/l and, secondly, with any cholest erol concentration, who might benefit from statin treatment for the followi ng: secondary prevention of coronary heart disease (CHD); primary preventio n at CHD risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention a t projected CHID risk 20% over 10 years (CHD risk at age 60 years if actual age < 60 years). Subjects-Random stratified sample of 3963 subjects aged 35-64 years from th e Scottish health survey 1995. Results-For secondary prevention 7.8% (95% confidence interval (CI) 6.9% to 8.6%) of the population with cholesterol <greater than or equal to> 5.0 mm ol/l would benefit from statins. For primary prevention, the prevalence of people at CHD risk 30%, 20%, 15%, and 6% over 10 years is 1.5% (95% CI 1.2% to 1.9%), 5.4% (95% CI 4.7% to 6.1%), 9.7% (95% CI 8.8% to 10.6%), and 32. 9% (95% CI 31.5% to 34.4%), respectively. At projected CHD risk 20% over 10 years, 12.4% (95% CI 11.4% to 13.5%) would be treated with statins. Removi ng the 5.0 mmol/l cholesterol threshold makes little difference to populati on prevalence at high CHD risk. Conclusions-Statin treatment would be required for 7.8% of the population f or secondary prevention. For primary prevention, among other factors, guide lines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The anal ysis supports a policy of targeting treatment at CHD risk 30% over 10 years as a minimum, as recommended in current British guidelines, with a move to treating at CHD risk 15% over 10 years as resources permit.