Lipids

Optimising use of statins in clinical practice: how to achieve the best clinical outcomes for every patient

Primary healthcare professionals have been set a series of challenges and dilemmas for the management of lipids in the updated Joint British Societies’ (JBS) guidelines for the prevention of cardiovascular disease (JBS2). In this article, we review the changes in emphasis of the new guidelines – teasing out how they can help to further reduce our patients’ risk of cardiovascular disease with tougher cholesterol targets than ever before, together with practical advice on how to achieve these targets.

The NICE Guidance On Statins – What’s New?

It would be easy to think that there was no more progress for statins to make. Since the publication of the landmark 4S study in the early 1990s, statins have become one of the most commonly prescribed drugs in the UK. But the recent publication of new NICE guidance on statins, and the second Joint British Societies guidance on cholesterol management for prevention of cardiovascular disease (JBS2) have changed the rules yet again. Under their recommendations, millions more patients become eligibile for statins to reduce their cholesterol.

Plant Sterols and Stanols: Further Options in Lowering Cholesterol

It is now 10 years since the introduction of the first cholesterol-lowering spread in the UK. There is now an expanding range of products including yoghurts, spreads and milk which include the active ingredients – plant sterols and stanols. With the increasing media focus and advertising spent on these so-called ‘functional food’ products, what advice should we be giving to our patients?

Monitoring Lipids in the Surgery

Testing patients’ lipids is an important measure in the detection and management of risk factors for cardiovascular disease (CVD). Cholesterol testing and management is one of the success stories of CVD prevention over the past few years. In this article, we review who we should be testing and what lipids we should be measuring. Looking to the future, testing a wider range of patients and using more aggressive treatment to reach targets will enable us to further reduce the number of patients suffering heart attacks and strokes.

How low can you go? Treating to new targets in cholesterol

Cardiovascular disease (CVD) remains the single biggest killer in the UK, accounting for 39% of deaths in the UK. It is important to remember CVD is not just a condition of old age, accounting for 36% of premature deaths among men and 27% among women. Several major clinical trials have shown that lowering cholesterol significantly reduces cardiovascular events and deaths. But how low should we go? The recent Treating to New Targets (TNT) trial suggested that it might be much lower than previously thought. Results showed that lowering LDL-cholesterol levels in patients with stable coronary heart disease (CHD) substantially below current targets achieved a significant further reduction in cardiovascular events.

Chewing the fat

Some fat is essential for maintaining good health, in order to provide essential fatty acids and the fat-soluble vitamins A, D, E and K. Essential fatty acids can only be derived from foods because they cannot be synthesised by the body. However, the hard truth is that essential fatty acids represent only a very small amount of total energy needs and most people still consume too much fat. How much fat should we be eating? What is the difference between different types of fats and what advice should we be giving patients about fats to reduce their risk of cardiovascular disease?

What to tell your patients about statins

An increasing number of patients are prescribed statins because of the growing evidence that they can dramatically reduce cardiovascular events. However, the withdrawal of one statin – cerivastatin – some time ago may have made some patients concerned about their safety. What should we be telling patients about the benefits of statins, how long they should take them for and whether there are any risks with these widely used agents?

Optimising lipid levels: looking beyond LDL-cholesterol

Treatment with statins is undoubtedly making a major contribution to reducing high-risk patients’ chance of a heart attack or another coronary event. However, their risk remains high, since over half of patients included in statin clinical trials suffered a further coronary event within five years. There is growing evidence that we need to move beyond simply lowering low-density lipoprotein cholesterol (LDL-C) and optimise the whole lipid profile.

Non-statin strategies for modifying lipids

Raised cholesterol is the commonest risk factor for CHD. Reducing cholesterol can be an effective way to help lower a patient’s risk of heart disease, particularly when cholesterol levels are already high. Dr Rubin Minhas looks at how to help patients to lower their cholesterol levels without drug treatment. He will discuss other lipid modifying drugs in future issues.

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The Keys to Optimising Lipid Management