CHD Treatment Targets

return to clinical biochemistry guidance

Lifestyle, risk factor, and therapeutic targets for prevention of CHD in patients with established CHD or other atherosclerotic disease and in healthy people at high risk of developing this disease

Lifestyle advice for all patients Stop smoking, make healthier food choices, increase aerobic exercise, and moderate alcohol consumption Body Mass Index <25 kg/m² is desirable with no central obesity

Targets for other risk factors
Patients with CHD or other atherosclerotic disease	People without overt CHD or other atherosclerotic disease at high risk (absolute CHD risk >15% over 10 years)
Blood pressure <140 mm Hg systolic and <85 diastolic
All patients to have blood pressure reduced to consistently <140/85 mm Hg	Systolic blood pressure >160 mm Hg or diastolic >100 mm Hg: Lifestyle advice and drug treatment if blood pressure is sustained at these levels on repeat, regardless of absolute CHD risk Systolic blood pressure 140-159 mm Hg or diastolic 90-99 mm Hg: If CHD risk >15% or target organ damage - lifestyle advice and drug treatment if blood pressure is sustained at these levels on repeat If CHD risk <15% and no target organ damage - lifestyle advice and reassess annually. Systolic blood pressure <140 mm Hg and diastolic <90 mm Hg: Lifestyle advice and reassess in 5 years.
Total cholesterol <5.0 mmol/l (LDL cholesterol <3.0 mmol/l)
All patients to have total cholesterol reduced to consistently below 5.0 mmol/l (LDL cholesterol <3.0 mmol/l).	Familial hypercholesterolaemia or other inherited dyslipidaemia: Lifestyle advice and drug treatment Total cholesterol >5.0 mmol/l: If CHD risk >15% - lifestyle advice and drug treatment if cholesterol sustained on repeat. If resources do not permit drug treatment at 15% then 30% is the minimum accepted standard of care. If CHD risk <15% - lifestyle advice; reassess annually if risk close to 15%
Patients with Diabetes Mellitus Total cholesterol <5.0 mmol/l (LDL cholesterol <3.0 mmol/l) Blood pressure <130 mm Hg systolic and <80 mm Hg diastolic (<125 mm Hg and <75 mm Hg diastolic when there is proteinuria) Optimal glycaemic control: Hba_1c <7%
Cardioprotective drug treatment
· Aspirin for all patients · b blockers at doses prescribed in clinical trials after myocardial infarction (AMI), particularly in high risk coronary patients and for at least 3 years · Cholesterol lowering agents (statins) at doses prescribed in clinical trials · ACE inhibitors at doses prescribed in clinical trials for patients with symptoms or signs of heart failure at time of AMI, or in those with persistent left ventricular systolic dysfunction (ejection fraction <40%) · Anticoagulants for patients at risk of systemic embolisation with large anterior infarctions, severe heart failure, left ventricular aneurysm, or paroxysmal tachyarrhythmias	· Aspirin (75 mg daily) in individuals aged >50 years whose hypertension, if present, is controlled.
Screening of first degree blood relatives
Screening of first degree blood relatives (principally siblings and offspring aged 18 years or older) of patients with premature CHD (men <55 years and women <65 years) or other atherosclerotic disease is encouraged and in the context of essential dyslipidaemias is essential	Screen close relatives if familial hypercholesterolaemia or other inherited dyslipidaemia is suspected.

top