The 'rule of halves' still applies to the management of cholesterol in cardiovascular disease: 2002-2005

The current national target in the UK for total cholesterol is 5 mmol/L. The Primary Care Data Quality (PCDQ) programme reported in 2002 that only 50% of patients with coronary heart disease (CHD) achieved the 5 mmol/L target and we report on progress since then. Routinely collected general practice computer data were extracted in two successive data collections in 2003 and 2004/05 and analysed. The standardised prevalence of CHD recorded in GP computer systems rose from 3.8% to 4.0% from 2002 to 2004/5. In patients with CHD, cholesterol recording rose from 47.6% to 89.0%, the percentage of patients receiving a statin rose from 49.4% to 71.5% and mean cholesterol levels fell from 5.18 to 4.67 mmol/L. The proportion of CHD patients with a cholesterol recording achieving the 5 mmol/L target increased from 44.7% to 67.7%. Overall, 53.1 % of patients with cardiovascular disease had total cholesterol below 5 mmol/L. Patients with CHD achieved better cholesterol control than those with stroke (4.87 mmol/L) or peripheral vascular disease (PVD) (4.79 mmol/L) and a higher percentage of patients achieved the 5 mmol/L target (60.1% versus 43.3% and 49.9% respectively). There remains scope for improved management of cholesterol in primary care and greater efforts are needed to see that more patients with cardiovascular disease benefit from best practice.