Moderate-risk patient with hypercholesterolemia: A pharmacy (P) model for decreasing LDL-cholesterol to reduce coronary heart disease risk

Introduction Cardiovascular diseases (CVD) are a leading cause of death in the UK. Coronary heart disease, the most prevalent CVD, accounts for 117 000 deaths yearly in the UK. Moreover, almost 270 000 individuals have a heart attack annually, and approximately 30% die before reaching health-care facilities. Priorities for CHD prevention in clinical practice are for patients with CHD or other major atherosclerotic disease. In addition, patients with diabetes are also a high-risk group. Major risk factors for CHD include cigarette smoking, an elevated LDL-cholesterol level (> 3.0 mmol/l), elevated blood pressure (systolic blood pressure ≥ 140 mm Hg; diastolic blood pressure ≥ 85 mm Hg), family history of premature CHD (CHD in male first degree relatives < 55 years; CHD in female first degree relatives < 65 years), and age (men ≥ 45 years; women ≥ 55 years). The ratio of serum total cholesterol to HDL-cholesterol is used to assess coronary risk; therefore, low HDL-cholesterol contributes to increased risk.The Joint British Societies have developed coronary risk prediction charts for men and women (smoking vs nonsmoking status) that are primarily linked to systolic blood pressure, and the ratio of serum total cholesterol to HDL-cholesterol, and stratified by age.