Cholesterol and hypertension

• in primary prevention, statin therapy is indicated up to the age of at least 80 years with a 10 year risk of cardiovascular disease of 20% (measured by using the new Joint British Societies' cardiovascular disease risk chart) and with total cholesterol concentration 3.5mmol/l
  
  
• in secondary prevention, the BHS guidelines state that a statin is indicated and to use sufficient doses to reach targets if patient is aged up to at least 80 years with a total cholesterol concentration 3.5 mmol/l

Notes:

• patients with type 2 diabetes are considered as for secondary prevention in this context
• target lipid concentrations are the same for primary and secondary prevention and have been made more stringent in light of the most recent trial evidence
• the new ideal targets are to lower total cholesterol by 25% or LDL cholesterol by 30% or to reach < 4.0 mmol/l or < 2.0 mmol/l respectively, whichever is the greater - however a total cholesterol concentration < 5.0 mmol/l or LDL cholesterol < 3.0 mmol/l or reductions of 25% or 30%, respectively (whichever is the greater), provides a minimal acceptable "audit" standard
• CVD risk replaces coronary heart disease (CHD) risk estimation to reflect the importance of stroke prevention as well as CHD prevention. The new CVD risk threshold of >= 20% is equivalent to a CHD risk of approximately >=15% over 10 years

Reference:

1. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004;18: 139-85