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Australian Journal of Pharmacy : November 2006
pharmacy ed u How low can you go? cdi drug news • approved CPE PBS eligibility criteria relaxed for cholesterol-lowering drugs HE use of lipid-lowering drugs will be increased following a review of the eligibility criteria by the Pharmaceutical Benefits Advisory Committee. Subsidised access to lipid- lowering medicines under the PBS will now be extended to approximately 250,000 more patients (see table below). It is well established that there is a continuous positive relationship between coronary heart disease (CHD) risk and blood cholesterol concentrations. The introduction of potent cholesterol- lowering drugs, such as the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) has made it T Patients identified as being in one of the following very high-risk categories may commence drug therapy with statins or fibrates at any cholesterol level: • coronary heart disease which has become symptomatic; • cerebrovascular disease which has become symptomatic; • peripheral vascular disease which has become symptomatic; • diabetes mellitus with microalbuminuria (defined as urinary albumin excretion rate of >20mg/min or urinary albumin to creatinine ratio of > 2.5 for males, > 3.5 for females); Patients’ categories Patients with diabetes mellitus not otherwise included Aboriginal or Torres Strait Islander patients Patients with hypertension Patients with HDL cholesterol < 1 mmol/L Patients with familial hypercholesterolaemia identified by: • DNA mutation; or • tendon xanthomas in the patient or their • first or second degree relative Patients with: • family history of coronary heart disease which has become symptomatic before the age of 60 years in one or more first degree relatives; • family history of coronary heart disease which has become symptomatic before the age of 50 years in one or more second degree relatives Patients not eligible under the above: • men aged 35 to 75 years • post-menopausal women aged up to 75 years Patients not otherwise included possible to reduce cholesterol levels significantly. However, it is not known if there is a definite threshold below which a lower cholesterol concentration is not associated with lower risk. In 1994, the decision was made to undertake periodic meta- analyses of individual participant data on mortality and morbidity from all relevant large-scale randomised trials of lipid- modifying treatments. A report of the results from the first cycle of such meta- analyses, and involves only trials of statins has been published.1 The study involved data from 90,056 individuals in 14 PBS eligibility criteria for cholesterol-lowering drugs from 1 October 2006 • diabetes mellitus in Aboriginal or Torres Strait Islander patients; • diabetes mellitus in patients aged 60 years or more; and • family history of coronary heart disease which has become symptomatic before the age of 55 years in two or more first degree relatives family history of coronary heart disease which has become symptomatic before the age of 45 years in one or more first degree relatives. Other patients are required to meet the lipid levels shown below. Lipid levels for PBS subsidy total cholesterol > 5.5mmol/L total cholesterol > 6.5mmol/L or total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L total cholesterol > 6.5mmol/L If aged more than 18 years at treatment initiation: LDL cholesterol > 4mmol/L If aged more than 18 years at treeatment initiation LDL cholesterol > 5mmol/L or total cholesterol > 6.5mmol/L or total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L total cholesterol > 7.5mmol/L or triglyceride > 4 mmol/L total cholesterol > 9mmol/L or triglyceride > 8mmol/L 78 ? THE AUSTRALIAN JOURNAL OF PHARMACY, VOl.87 NOVEMBER 2006