A lack of resources is hampering attempts to implement an effective strategy to combat the problem of coronary heart disease in the United Kingdom, which has some of the highest rates of the disease in the world, a consensus conference held last week has concluded.
The conference, organised by the Royal College of Physicians of Edinburgh, examined the issue of lowering lipids to prevent vascular events and called for a clear commitment by the government to implement preventive policies of proved value.
The conference agreed that a joint approach needs to be taken involving action to encourage the public to improve their diet, reduce smoking, and increase exercise as well as implementing direct intervention among individuals at highest risk .
People with a 3%or greater annual risk of having a major coronary heart disease event should be targeted for treatment with statins, which have been shown in clinical trials to reduce the incidence of such events. This treatment standard has already been recommended by the Standing Medical Advisory Committee in England and Wales.
The consensus statement also declared that there is compelling evidence to extend the use of these drugs progressively to those with a 1.5%annual risk “as resources and costs permit.”
Although the use of statins has increased substantially in the United Kingdom over the past few years, many people who could benefit from the drugs are still not receiving them. Figures from England and Wales show regional disparities in use with some of the highest prescribing in areas of lowest need.
To counteract this effect, the conference recommended that general practices working in areas of deprivation, where the prevalence of coronary heart disease is highest, be given extra resources to be able to respond to identified needs.
It has been estimated that in an average Scottish general practice of 10000 patients, there will be 353 candidates for secondary prevention and 121 for primary prevention at a 3%annual level of risk. Prescribing statins for these patients would cost about £150000-£200000 ($240000-$320000).
The conference recommended that all practices should develop a system for managing patients whose multiple risk factors would allow them to be identified opportunistically.
However, some general practitioners at the conference complained that family doctors did not have the time, the resources, or the training to take on the task of identifying people who could benefit from this preventive approach.
Dr Christopher Isles, a consultant physician at Dumfries and Galloway Royal Infirmary and a member of the conference organising committee, said that it would take some time to close the gap between what is achievable in the United Kingdom and what is affordable.
Bryan Christie was a member of the panel that drew up the consensus statement.