Use of the 1996 Updated Sheffield Table for Primary Prevention of Coronary Disease

Description

Statins (inhibitors of hydroxymethyl-glutaryl-coA-reductase) have been shown to be beneficial if the serum cholesterol averages at least 5.5 mmol/L and if the risk of myocardial infarction or coronary death is at least 1.5% per year. The Sheffield tables were designed to give a simple estimate of coronary heart disease risk and to help guide treatment with statins for prevention of primary coronary heart disease. They are based on a logistic regression equation for predicting coronary risk based on the Framingham population. They were published in 1995 and subsequently updated in 1996.

Steps:

(1) Determine if the person has a history of myocardial infarction, angina, peripheral vascular disease or symptomatic carotid artery disease. If so, the person already is at high risk and requires treatment. If not, proceed to step 2.

(2) Determine the patient's risk factors for hypertension, smoking, diabetes mellitus and left ventricular hypertrophy to determine the person's risk "column".

(3) Look up the value in the tables based on gender, age and column.

(4) If the value is "NA", then serum cholesterol does not need to be measured. The risk of coronary heart disease is < 3% per year.

(5) If a numerical value is present, then:

(5a) The serum total cholesterol should be measured and reported in mmol/L. The cholesterol should be determined twice and the mean taken.

(5b) If the mean cholesterol value is less than the value in the table, then the risk is < 3% per year.

(5c) If the mean cholesterol value is greater than or equal to the value in the table, then the risk is >= 3% per year.

(6) The tables are valid for British, Northern European and North American populations. Persons from Southern Europe or the Far East have a lower risk of coronary heart disease for a given set of risk factors.

Hypertension	Smoking	Diabetes	LVH on ECG	Column
Yes	Yes	Yes	Yes	1
Yes	Yes	No	Yes	2
Yes	Yes	Yes	No	3
Yes	No	Yes	Yes	4
Yes	Yes	No	No	5
Yes	No	No	Yes	6
No	Yes	Yes	No	7
No	Yes	No	No	8
Yes	No	Yes	No	9
Yes	No	No	No	10
No	No	Yes	No	11
No	No	No	No	12

where:

• LVH = left ventricular hypertrophy

• The 4 variables theoretically have 16 possible combinations. However, left ventricular hypertrophy is only graded in the presence of hypertension.

Males

Age	1	2	3	4	5	6
<= 29	NA	NA	NA	NA	NA	NA
30	8.7	NA	NA	NA	NA	NA
32	7.6	NA	NA	NA	NA	NA
34	6.7	8.6	NA	NA	NA	NA
36	6.0	7.6	8.8	NA	NA	NA
38	5.5	6.8	7.9	NA	NA	NA
40	5.5	6.1	7.1	9.0	NA	NA
42	5.5	5.6	6.4	8.2	NA	NA
44	5.5	5.5	5.8	7.4	9.0	NA
46	5.5	5.5	5.5	6.8	8.2	NA
48	5.5	5.5	5.5	6.2	7.5	8.9
50	5.5	5.5	5.5	5.7	6.9	8.2
52	5.5	5.5	5.5	5.5	6.3	7.6
54	5.5	5.5	5.5	5.5	5.9	7.0
56	5.5	5.5	5.5	5.5	5.5	6.5
58	5.5	5.5	5.5	5.5	5.5	6.1
60	5.5	5.5	5.5	5.5	5.5	5.6
62	5.5	5.5	5.5	5.5	5.5	5.5
64	5.5	5.5	5.5	5.5	5.5	5.5
66	5.5	5.5	5.5	5.5	5.5	5.5
68	5.5	5.5	5.5	5.5	5.5	5.5
70	5.5	5.5	5.5	5.5	5.5	5.5

Age	7	8	9	10	11	12
<= 29	NA	NA	NA	NA	NA	NA
30	NA	NA	NA	NA	NA	NA
32	NA	NA	NA	NA	NA	NA
34	NA	NA	NA	NA	NA	NA
36	NA	NA	NA	NA	NA	NA
38	NA	NA	NA	NA	NA	NA
40	NA	NA	NA	NA	NA	NA
42	NA	NA	NA	NA	NA	NA
44	NA	NA	NA	NA	NA	NA
46	NA	NA	NA	NA	NA	NA
48	NA	NA	NA	NA	NA	NA
50	8.8	NA	NA	NA	NA	NA
52	8.1	9.3	NA	NA	NA	NA
54	7.5	8.6	9.0	NA	NA	NA
56	7.0	8.0	8.3	NA	NA	NA
58	6.5	7.4	7.7	8.9	NA	NA
60	6.0	6.9	7.2	8.3	8.9	NA
62	5.6	6.5	6.7	7.8	8.3	NA
64	5.5	6.1	6.3	7.3	7.8	9.3
66	5.5	5.7	5.9	6.8	7.3	8.7
68	5.5	5.5	5.6	6.4	6.9	8.2
70	5.5	5.5	5.5	6.0	6.5	7.7

Females

Age	1	2	3	4	5	6
<= 35	NA	NA	NA	NA	NA	NA
36	9.7	NA	NA	NA	NA	NA
38	8.0	NA	NA	NA	NA	NA
40	6.7	9.9	NA	NA	NA	NA
42	5.8	8.5	9.8	NA	NA	NA
44	5.5	7.5	8.6	NA	NA	NA
46	5.5	6.7	7.7	NA	NA	NA
48	5.5	6.0	6.9	9.3	NA	NA
50	5.5	5.5	6.4	8.5	9.3	NA
52	5.5	5.5	5.9	7.9	8.7	9.4
54	5.5	5.5	5.5	7.4	8.1	8.9
56	5.5	5.5	5.5	7	7.7	8.4
58	5.5	5.5	5.5	6.7	7.3	8.0
60	5.5	5.5	5.5	6.4	7.0	7.7
62	5.5	5.5	5.5	6.2	6.8	7.4
64	5.5	5.5	5.5	6.1	6.6	7.2
66	5.5	5.5	5.5	5.9	6.5	7.1
68	5.5	5.5	5.5	5.8	6.4	7.0
70	5.5	5.5	5.5	5.8	6.3	6.9

Age	7	8	9	10	11	12
<= 35	NA	NA	NA	NA	NA	NA
36	NA	NA	NA	NA	NA	NA
38	NA	NA	NA	NA	NA	NA
40	NA	NA	NA	NA	NA	NA
42	NA	NA	NA	NA	NA	NA
44	NA	NA	NA	NA	NA	NA
46	NA	NA	NA	NA	NA	NA
48	NA	NA	NA	NA	NA	NA
50	NA	NA	NA	NA	NA	NA
52	NA	NA	NA	NA	NA	NA
54	NA	NA	NA	NA	NA	NA
56	NA	NA	NA	NA	NA	NA
58	9.8	NA	NA	NA	NA	NA
60	9.4	NA	NA	NA	NA	NA
62	9.1	NA	NA	NA	NA	NA
64	8.9	NA	NA	NA	NA	NA
66	8.7	10.0	NA	NA	NA	NA
68	8.6	9.9	NA	NA	NA	NA
70	8.5	9.8	NA	NA	NA	NA

Treatment to lower cholesterol is indicated for persons

(1) already manifesting signs of coronary heart or atherosclerotic disease

(2) if the risk for coronary heart disease is >= 3% per year.

Persons with low HDL cholesterol,a strong family history of premature coronary artery disease, or a familial lipid disorder may also benefit from cholesterol lowering treatment.

Persons with risk factors should have interventions to reduce these factors:

(1) Antihypertensive medications if hypertensive, with systolic blood pressure <= 160 mm Hg

(2) Blood glucose control in diabetes mellitus, as reflected with glycated hemoglobin

(3) Smoking cessation if a smoker

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Description

Specialty

ICD-10

Hypertension	Smoking	Diabetes	LVH on ECG	Column
Yes	Yes	Yes	Yes	1
Yes	Yes	No	Yes	2
Yes	Yes	Yes	No	3
Yes	No	Yes	Yes	4
Yes	Yes	No	No	5
Yes	No	No	Yes	6
No	Yes	Yes	No	7
No	Yes	No	No	8
Yes	No	Yes	No	9
Yes	No	No	No	10
No	No	Yes	No	11
No	No	No	No	12

Hypertension	Smoking	Diabetes	LVH on ECG	Column
Yes	Yes	Yes	Yes	1
Yes	Yes	No	Yes	2
Yes	Yes	Yes	No	3
Yes	No	Yes	Yes	4
Yes	Yes	No	No	5
Yes	No	No	Yes	6
No	Yes	Yes	No	7
No	Yes	No	No	8
Yes	No	Yes	No	9
Yes	No	No	No	10
No	No	Yes	No	11
No	No	No	No	12

Hypertension	Smoking	Diabetes	LVH on ECG	Column
Yes	Yes	Yes	Yes	1
Yes	Yes	No	Yes	2
Yes	Yes	Yes	No	3
Yes	No	Yes	Yes	4
Yes	Yes	No	No	5
Yes	No	No	Yes	6
No	Yes	Yes	No	7
No	Yes	No	No	8
Yes	No	Yes	No	9
Yes	No	No	No	10
No	No	Yes	No	11
No	No	No	No	12