At 17:54 03/10/1996 +0100, Peter wrote:
>Can I get some ideas from the "coalface" of general practice? I've a
>72yr. old patient who had her first migrainous headache a few months
>ago.I discussed her with our local neurologist who said,yes, it was a
>bit uncommon but do a few bloods and wait and see if she gets more
>before getting alarmed.Fairly wise as it turned out as she's had no more
>but for some reason I included a lipid screen in her investigations and
>her cholesterol came back as 9.6 and has not improved on dietary
>treatment.She has no history or symptoms of IHD and her parents died of
>old age. One sister had an MI at age 65+. I'm inclined to ignore it.
>What would you do? I'd be most grateful for your opinions.
Prof Ramsey in Sheffield has produced a really nice short paper on treating
raised cholesterol. Sorry can't remeber the reference, I can get it for you
if wish (seem to think it was in the Lancet).
Basically it looks at risk factors. If your lady (and if I remeber this
right) doesn't have hypertension, diabetes, LVH and isn't a smoker, then as
I recall her risk of a serious cardiac event is less than 3% per year. For
her risk to be greater than this her cholesterol would need to be over 10.
The 3% level is the average risk of a serious cardiac event for post MI and
angina patients. So you don't need to treat.
Prof Ramsey gave an evening lecturer recently in Rotherham. The "terrifying"
consequences of the 4S and WOSCOPS (?) studies prove that primary and
secondary prevention of IHD by targeting risk factors and in particularly
raised cholesterol are that the NHS drug bill could rise by over 25%
treating at this 3% risk level. Buy shares in drug companies selling
'statins now. You'll make a killing (sic), especially as you then wouldn't
be able to prescribe their drugs:-)
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Dr David J Plews
email: [log in to unmask]
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