Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey

L. E. Ramsay, I. U. Haq, E. J. Wallis, C. G. Isles, Lewis Duthie Ritchie, P. R. Jackson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective-To determine the proportion of the population, firstly, with cholesterol greater than or equal to 5.0 mmol/l and, secondly, with any cholesterol concentration, who might benefit from statin treatment for the following: secondary prevention of coronary heart disease (CHD); primary prevention at CHD risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention at 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 the 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 mmol/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. Removing the 5.0 mmol/l cholesterol threshold makes little difference to population prevalence at high CHD risk.

Conclusions-Statin treatment would be required for 7.8% of the population for secondary prevention. For primary prevention, among other factors, guidelines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The analysis 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.

Original languageEnglish
Pages (from-to)289-295
Number of pages6
JournalHeart
Volume86
DOIs
Publication statusPublished - 2001

Keywords

  • statins
  • coronary risk
  • secondary prevention
  • primary prevention
  • AVERAGE CHOLESTEROL LEVELS
  • CLINICAL-PRACTICE
  • RISK
  • PRAVASTATIN
  • EVENTS
  • TRIALS
  • MEN

Cite this

Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey. / Ramsay, L. E.; Haq, I. U.; Wallis, E. J.; Isles, C. G.; Ritchie, Lewis Duthie; Jackson, P. R.

In: Heart, Vol. 86, 2001, p. 289-295.

Research output: Contribution to journalArticle

Ramsay, L. E. ; Haq, I. U. ; Wallis, E. J. ; Isles, C. G. ; Ritchie, Lewis Duthie ; Jackson, P. R. / Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey. In: Heart. 2001 ; Vol. 86. pp. 289-295.
@article{1143742498d9436bb74ccc6739142f17,
title = "Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey",
abstract = "Objective-To determine the proportion of the population, firstly, with cholesterol greater than or equal to 5.0 mmol/l and, secondly, with any cholesterol concentration, who might benefit from statin treatment for the following: secondary prevention of coronary heart disease (CHD); primary prevention at CHD risk 30{\%}, 20{\%}, 15{\%}, and 6{\%} over 10 years; and primary prevention at 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 the Scottish health survey 1995.Results-For secondary prevention 7.8{\%} (95{\%} confidence interval (CI) 6.9{\%} to 8.6{\%}) of the population with cholesterol 5.0 mmol/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. Removing the 5.0 mmol/l cholesterol threshold makes little difference to population prevalence at high CHD risk.Conclusions-Statin treatment would be required for 7.8{\%} of the population for secondary prevention. For primary prevention, among other factors, guidelines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The analysis 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.",
keywords = "statins, coronary risk, secondary prevention, primary prevention, AVERAGE CHOLESTEROL LEVELS, CLINICAL-PRACTICE, RISK, PRAVASTATIN, EVENTS, TRIALS, MEN",
author = "Ramsay, {L. E.} and Haq, {I. U.} and Wallis, {E. J.} and Isles, {C. G.} and Ritchie, {Lewis Duthie} and Jackson, {P. R.}",
year = "2001",
doi = "10.1136/heart.86.3.289",
language = "English",
volume = "86",
pages = "289--295",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",

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TY - JOUR

T1 - Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey

AU - Ramsay, L. E.

AU - Haq, I. U.

AU - Wallis, E. J.

AU - Isles, C. G.

AU - Ritchie, Lewis Duthie

AU - Jackson, P. R.

PY - 2001

Y1 - 2001

N2 - Objective-To determine the proportion of the population, firstly, with cholesterol greater than or equal to 5.0 mmol/l and, secondly, with any cholesterol concentration, who might benefit from statin treatment for the following: secondary prevention of coronary heart disease (CHD); primary prevention at CHD risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention at 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 the Scottish health survey 1995.Results-For secondary prevention 7.8% (95% confidence interval (CI) 6.9% to 8.6%) of the population with cholesterol 5.0 mmol/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. Removing the 5.0 mmol/l cholesterol threshold makes little difference to population prevalence at high CHD risk.Conclusions-Statin treatment would be required for 7.8% of the population for secondary prevention. For primary prevention, among other factors, guidelines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The analysis 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.

AB - Objective-To determine the proportion of the population, firstly, with cholesterol greater than or equal to 5.0 mmol/l and, secondly, with any cholesterol concentration, who might benefit from statin treatment for the following: secondary prevention of coronary heart disease (CHD); primary prevention at CHD risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention at 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 the Scottish health survey 1995.Results-For secondary prevention 7.8% (95% confidence interval (CI) 6.9% to 8.6%) of the population with cholesterol 5.0 mmol/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. Removing the 5.0 mmol/l cholesterol threshold makes little difference to population prevalence at high CHD risk.Conclusions-Statin treatment would be required for 7.8% of the population for secondary prevention. For primary prevention, among other factors, guidelines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The analysis 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.

KW - statins

KW - coronary risk

KW - secondary prevention

KW - primary prevention

KW - AVERAGE CHOLESTEROL LEVELS

KW - CLINICAL-PRACTICE

KW - RISK

KW - PRAVASTATIN

KW - EVENTS

KW - TRIALS

KW - MEN

U2 - 10.1136/heart.86.3.289

DO - 10.1136/heart.86.3.289

M3 - Article

VL - 86

SP - 289

EP - 295

JO - Heart

JF - Heart

SN - 1355-6037

ER -