Ischaemic heart disease and cholesterol

Cholesterol-lowering therapy is an area of medicine that has prompted heated debate and a great deal of confusion.

Hypercholesterolaemia treatment can be considered in terms of primary and secondary prevention of coronary heart disease.

In general, the treatment of choice for raised cholesterol is a statin.

NICE state that (1):

• before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include:
  • smoking status
  • alcohol consumption
  • blood pressure
  • body mass index or other measure of obesity
  • fasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available)
  • fasting blood glucose
  • renal function
  • liver function (transaminases)
  • thyroid-stimulating hormone (TSH) if dyslipidaemia is present

Reference:

• (1) NICE (May 2008).Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease