nhs forth valley formulary 11 - Community Pharmacy

Forth Valley Formulary Eleventh Edition 2012/13Appendix 5SECONDARY PREVENTION OF CARDIOVASCULAR DISEASEEstablished occlusive arterial disease- Coronary heart disease- Cerebrovascular disease- Peripheral vascular diseaseTreat all patients with statins regardless of baseline cholesterolconcentration.See treatment flowchartAll patients should have LFTs performed prior to statin treatmentATHEROSCLEROTIC ARTERIAL DISEASE IS OF MULTIFACTORIAL ORIGIN.NO SINGLE RISK FACTOR, INCLUDING CHOLESTEROL CONCENTRATION,SHOULD BE VIEWED IN ISOLATION.• Encourage smoking cessation (consider nicotine replacement therapy)• All other risk factors hypertension, diabetic control, should be addressed (see separate guidelines)• An antiplatelet agent (see separate guideline) should be taken by all those with occlusive arterialdisease in the absence of contraindications (active peptic ulceration, a bleeding disorder, or truehypersensitivity)• Treat with ACE-inhibitors unless contraindicated• Consider β-blockers, and ensure attendance at a rehabilitation programme, for patients after MI• Dietary and other lifestyle advice e.g. alcohol, obesity, physical activity, should be given.Goals of TreatmentFor secondary prevention, the ideal target is total cholesterol concentration of < 4 mmol/L.NICE recommends an audit target of total cholesterol of