The Lipid Modification Guideline recently published by the National Institute for Health and Clinical Excellence (NICE) has sparked debate in the British Medical Journal.
Two letters express opinions that the guideline is flawed. The first letter states the risks could be over estimated by adding together heart and stroke risks. NICE opted to use Framingham rather than QRISK for risk calculation.
The second letter questions the feasibility of aspirational cholesterol targets of less than 4 mmol/L for total cholesterol and 2 mmol/L for low density lipoprotein (LDL) cholesterol when the statin recommendation is simvastatin 40mg for all patients.
Action: Clinicians should familiarise themselves with the guidance fully before changing practice or attempting implementation. Audit standards remain at cholesterol levels of 5mmol/L and LDL of 3mmol/L.