The Joint British Societies (JBS) have published Guidelines on the prevention of cardiovascular disease in clinical practice. The publication has been reported by the BBC and is available in full online or as a PDF.
The guidelines suggest a consistent multidisciplinary approach to the management of people with established cardiovascular disease (CVD) and those at high risk of developing CVD. This statement is clarified to include people:
- with established CVD
- with a CVD risk of > 20% in 10 years
- with diabetes (Type 1 or 2)
In addition, people with particularly elevated single risk factors are considered at high risk, specified as people:
- with blood pressure above 160/100mmHg (or lower with target organ damage)
- with total cholesterol to high density lipid ratio (TC:HDL) above 6
- with familial dyslipidaemia
NOTE: The guidance seems to infer that patients in the above three categories should have interventions appropriate to their risk. A full CVD Risk assessment should be undertaken before initiating polypharmacy for CVD prevention.
The guideline goes on to recommend lifestyle advice and treatment targets in the key areas of blood pressure management, blood lipid management, blood glucose management and antiplatelet therapy. Drug choice in each of these areas has already been covered.
Action: Clinicians should receive a copy of the guidelines from the JBS. NICE are expected to publish Cardiovascular Disease - Statins guidance in January 2006 and to review the Hypertension guideline in May 2006. In the meantime continue to follow the formulary advice and the NICE Hypertension Guideline.