2.12 Lipid-regulating drugs

 General guidance

Click here to see NHS Dudley Lipid Management Guidelines
and
Click here to see Lipid Management Flowchart

• Coronary heart disease is a multifactorial disease of which dyslipidaemia is only one contributing factor. It is important to target interventions at those groups most likely to gain the greatest health benefit.
• The use of lipid regulating drugs must be viewed within the overall range of effective interventions for secondary prevention patients: aspirin, beta-blockers, ACE inhibitors, smoking cessation, diet, cardiac rehabilitation programs.
• The use of lipid regulating drugs in primary prevention should also be viewed within the context of other effective interventions: smoking cessation, hypertension control, diet, exercise, which need to be considered before drug therapy.
• Consideration of the appropriateness for drug treatment in primary prevention must not be based solely on cholesterol levels but on the overall absolute risk of CHD assessed using Qrisk cardiovascular risk calculator.
• Tredaptive has had its licence withdrawn January 2013 across Europe after a study has shown a failure to reduce major vascular events and an increase in non-fatal serious adverse events. Both the Committee for Medicinal Products for Human Use (CHMP) and the Pharmacovigilance Risk Assessment Committee have concluded that the benefits no longer outweigh the risks.  See here for letter from Dr Labib and Clair Huckerby for recommendations to prescribers in Dudley.

Recommended drugs

Statin

Simvastatin £

Atorvastatin £ 

Pravastatin £

Rosuvastatin £££

Fibrate

Fenofibrate ££

Other

Tredaptive - WITHDRAWN see above £££

Adjunct

Ezetimibe £££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low