Secondary Prevention of Coronary Heart Disease and Stroke – Cholesterol Guideline

Below is brief guidance on the management of cholesterol. For full guidance see NHSGGC StaffNet / Clinical Info / Clinical Guidelines Directory and search for 'Coronary heart disease and stroke, primary and secondary prevention guidelines (cholesterol)'. 

Patients with established vascular disease are at high risk and should be treated with a statin regardless of total blood cholesterol concentration i.e. previous MI / pre- or post-CABG / pre- or post-angioplasty / angina / angiographic coronary artery disease / ischaemic stroke or transient ischaemic attack / peripheral arterial disease / diabetic patients aged ≥40 years.

• Flowchart Cholesterol Management Flowchart

Atherosclerotic 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 - see Appendix 1).
• Dietary and other lifestyle advice e.g. alcohol, obesity, physical activity, should be given.
• All other risk factors; hypertension, diabetic control, should be addressed (see separate guidelines on NHSGGC StaffNet, Clinical Guideline Electronic Resource Directory).
• Aspirin oral dispersible 75mg daily (not enteric coated) should be taken by all those with occlusive arterial disease in the absence of contraindications (active peptic ulceration, a bleeding disorder or true hypersensitivity).
• Consider treatment with ACE inhibitors, especially in patients with left ventricular dysfunction or heart failure.
• Consider beta-blockers, and ensure attendance at a rehabilitation programme, for patients after myocardial infarction.
• With statins, check BNF for cautions, contraindications and clinically important drug interactions (e.g. clarithromycin, calcium channel blockers).