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Risk estimation and the prevention of cardiovascular disease by Scottish Intercollegiate Guidelines Network.

By Scottish Intercollegiate Guidelines Network.

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210 In the CARE study, 586 subjects with a clinical diagnosis of diabetes were identified. 001). Although the reduction in CHD events in subjects with diabetes was not significant with pravastatin, the test for heterogeneity in response between subjects with and without diabetes was not statistically significant. In AFCAPS/TexCAPS, a primary prevention study, only 155 subjects had a clinical diagnosis of diabetes. 1). 2 Familial Hypercholesterolaemia Subjects with familial hypercholesterolaemia based on clinical or genetic evidence should be considered for aggressive statin therapy, irrespective of their calculated cardiovascular risk.

Patients with uncontrolled blood pressure are at greater risk of cerebral haemorrhage and should not receive antiplatelet therapy until their blood pressure is treated to <150/90 mm Hg.  1++ Patients with hypertension should be treated with aspirin if their ten year cardiovascular disease risk exceeds 20%, and only once their blood pressure is treated to <150/90 mm Hg. 1 the role of total and low density lipoprotein cholesterol in cardiovascular disease The link between cardiovascular risk and variation in blood lipid concentration was shown in a study of over 356,000 men aged 35-57 years who were followed up for six years.

62 mmol/l). 006) and reduced stroke and transient ischaemic attack risk by 31% and 59% respectively. The main lipid changes were a 6% increase in HDL cholesterol and a 31% fall in triglyceride. 227,228 This may help explain why the magnitude of reduction of events with gemfibrozil was greater than appeared likely from HDL cholesterol increases alone. 1++ The consistency of these major fibrate-based trials supports the view that HDL cholesterol elevation and triglyceride reduction offer cardiovascular benefit which, at least in part, is independent of LDL cholesterol reduction.

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