nhs forth valley formulary 11 - Community Pharmacy

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Forth Valley Formulary Eleventh Edition 2012/13Appendix 5PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE1. WITH NO DIABETESAll adults from 40 years onward should have their cholesterol measuredas part of an opportunistic CVD risk assessment in Primary Care.Measure random non-fasting totalcholesterol and HDL-cholesterolas part of a CVD risk assessmentTotal CVD risk * > or =20%Measure fasting lipid profileand LFTsTotal CVD risk* < 20% andno cardiovascular complications andno diabetesTotal CVD risk * > or =20%Lifestyle advice,Initiate sim vastatin 40m g ** daily.See BNF for cautions and contraindications.Treat and forget strategy.Check LFTs in 8 weeks.Lifestyle advice and follow up, ideallywithin 5 years, to repeatcardiovascular risk assessment*Assess CVD risk using the ASSIGN score.Consider secondary and familial hyperlipidaemia if cholesterol > 8.0mmol/L.Discuss with lipid clinic if in doubt.**In case of side effects with simvastatin 40mg daily try pravastatin 40mg daily(see BNF for cautions and contraindications).PREVENTION OF ATHEROSCLEROTIC ARTERIAL DISEASE REQUIRES CONTROL OFALL RISK FACTORS. NO SINGLE RISK FACTOR, INCLUDING CHOLESTEROL, SHOULDBE VIEWED IN ISOLATION.• All other risk factors (e.g. smoking, hypertension) should be addressed.• Dietary and other lifestyle advice (e.g. alcohol, obesity, physical activity) should begiven.Certain individuals are at higher risk than CVD risk charts predict.Higher risk occurs in:• Familial dyslipidaemia (e.g. hypercholesterolaemia, familial combinedhyperlididaemia, or other inherited dyslipidaemia)• People with raised triglyceride levels (>1.7mmol/fasting)• Those who are not yet diabetic, but have impaired fasting glucose (6.1-6.9 mmol/l)or impaired glucose tolerance (7.8-<strong>11</strong>mmol/l).• Women with premature menopause• People of south Asian descent, i.e. originating from the Indian subcontinent• People with central obesity (waist circumference >102cm in men and >88cm inwomen)Page 56
Forth Valley Formulary Eleventh Edition 2012/13Appendix 52. WITH DIABETESSIGN <strong>11</strong>6 recommends:• Lipid lowering therapy with simvastatin 40mg for primary prevention in patientswith type 2 diabetes aged > 40 years regardless of baseline cholesterol.• Lipid lowering therapy with simvastatin 40mg should be considered for primaryprevention in patients with type 1 diabetes aged > 40 years.• Patients < 40 years with type 1 or type 2 diabetes and other important risk factors*should be considered for primary prevention lipid lowering therapy with simvastatin40mg.*Further risk factors• Retinopathy (preproliferative, proliferative, maculopathy)• Nephropathy, including persistent microalbuminuria• Poor glycaemic control (HbA1c>9%)• Features of metabolic syndrome (central obesity; fasting triglycerides >1.7 mmol/l[non-fasting >2.0 mmol/l] and/or HDL cholesterol
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