| Back to main Menu |
| Back to Clinical |
In patients whose total cholesterol is greater than 5.0mmol/l, statin therapy to reduce cholesterol should be initiated and titrated as necessary to reduce total cholesterol to less than 5mmol/l. There is ongoing debate concerning the intervention levels of serum cholesterol in diabetic patients who do not apparently have CVD.
The age when a statin should be initiated is unclear. It is pragmatically suggested that the prescription of a statin should be considered for all diabetic patients over the age of 40 years, particularly if their cholesterol is greater than 5.0mmol/l. Below the age of 40 years a decision needs to be reached between the doctor and the patient and may involve assessment of other risk factors and the actual age of the patient.
Further information
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of
cholesterollowering with simvastatin in 5963 people with diabetes: a randomised
placebo-controlled trial (Lancet 2003; 361:2005-2016). Mortality from CHD in
Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior
Myocardial Infarction Haffner et al (NEJM 1998; 339: 229-234)
SIGN clinical guideline 97 (2007). Risk estimation and the prevention
of CVD.
http://www.sign.ac.uk/guidelines/fulltext/97/index.html
The practice reports the percentage of patients on the diabetes register whose last measured cholesterol was 5mmol/l or less. The measurement should have been carried out in the preceding 15 months.
In verifying that this information has been correctly recorded, a number of approaches could be taken:
1. inspection of the output from a computer search that has been used to provide information on this indicator
2. inspection of a sample of records of patients with diabetes to look at the proportion with recorded serum cholesterol less than 5mmol/l
3. inspection of a sample of records of patients for whom a record of serum cholesterol is less than 5mmol/l is claimed, to see if there is evidence of this in the medical records.
Prepared By Jean Keenan