Sheffield
tables for primary prevention of coronary heart disease: womenThe new Sheffield table - women
Notes on use of table
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Do not use for decisions on secondary prevention : patients with myocardial infarct, angina, peripheral vascular disease, non-haemorrhagic stroke, TIA or diabetes with microvascular complications already have high CHD risk. Treat mild hypertension, treat with aspirin and treat with statin if serum cholesterol > 5mmol/l.
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Treat hypertension above the mild range (>160 or >100).
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Treat mild hypertension (140-159 or 90-99) with target organ damage (LVH, proteinuria, renal impairment) or diabetes (type I or II).
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Consider drug treatment only after 6 months of appropriate advice on smoking, diet and repeated BP measurements.
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Use average of repeated total:HDL-C measurements. If HDL-C not available, assume 1.3mmol/l.
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Those with total:HDL-C ratio >8.0 may have familial hyperlipidaemia.
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The table underestimates the risk in
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LVH on ECG (risk doubled - add 20 years to age)
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familial history of premature CHD (add 6 years)
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familial hyperlipidaemia
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British Asians
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Using the table
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Hypertension means SBP>140 or DBP>90 or on antihypertensive treatment.
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Identify correct column for hypertension, smoking and diabetes.
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Identify row showing age.
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Read off total:HDL-C ratios at intersection of column and row. If there is an entry, measure serum cholesterol:HDL ratio. If no entry, lipids need not be measured unless familial hyperlipidaemia suspected.
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If total:HDL-C ratio confers CHD risk of 15%, consider treatment of mild hypertension (SBP 140-159 or DBP 90-99) and with aspirin.
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If total:HDL-C ratio confers CHD risk of 30%, consider statin if serum cholesterol >5.0mmol/l.
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Decisions on statin at CHD risk between 15-30% depend on local policy.
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The table can be used to assess risk at an older age.
References
Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population. Wallace EJ, Ramsay LE, Haq I, Ghahramani P, Jackson PR, Rowland-Yeo K, et al. BMJ 2000; 320: 671-676
The old Sheffield table - women
Showing serum cholesterol concentration conferring an estimated risk of coronary events of 3.0% per year
Women: Cholesterol concentration (mmol/L)
| Hypertension Smoking Diabetes LVH on ECG** |
Yes Yes Yes Yes |
Yes No Yes Yes |
Yes Yes No Yes |
Yes Yes Yes No |
Yes No No Yes |
No Yes Yes No |
Yes No Yes No |
Yes Yes No No |
No No Yes No |
No Yes No No |
Yes No No No |
No No No No |
| Age (years) | ||||||||||||
| 70 | 5.5 | 5.5 | 5.5 | 5.8 | 6.3 | 6.9 | 8.5 | 9.8 | ||||
| 68 | 5.5 | 5.5 | 5.5 | 5.8 | 6.4 | 7.0 | 8.6 | 9.9 | ||||
| 66 | 5.5 | 5.5 | 5.5 | 5.9 | 6.5 | 7.1 | 8.7 | 10.0 | ||||
| 64 | 5.5 | 5.5 | 5.5 | 6.1 | 6.6 | 7.2 | 8.9 | |||||
| 62 | 5.5 | 5.5 | 5.5 | 6.2 | 6.8 | 7.4 | 9.1 | |||||
| 60 | 5.5 | 5.5 | 5.5 | 6.4 | 7.0 | 7.7 | 9.4 | |||||
| 58 | 5.5 | 5.5 | 5.5 | 6.7 | 7.3 | 8.0 | 9.8 | |||||
| 56 | 5.5 | 5.5 | 5.5 | 7.0 | 7.7 | 8.4 | ||||||
| 54 | 5.5 | 5.5 | 5.5 | 7.4 | 8.1 | 8.9 | ||||||
| 52 | 5.5 | 5.5 | 5.9 | 7.9 | 8.7 | 9.4 | ||||||
| 50 | 5.5 | 5.5 | 6.4 | 8.5 | 9.3 | |||||||
| 48 | 5.5 | 6.0 | 6.9 | 9.3 | ||||||||
| 46 | 5.5 | 6.7 | 7.7 | |||||||||
| 44 | 5.5 | 7.5 | 8.6 | |||||||||
| 42 | 5.8 | 8.5 | 9.8 | |||||||||
| 40 | 6.7 | 9.9 | ||||||||||
| 38 | 8.0 | |||||||||||
| 36 | 9.7 | |||||||||||
| less than 35 | ||||||||||||
| Hypertension Smoking Diabetes LVH on ECG** |
Yes Yes Yes Yes |
Yes No Yes Yes |
Yes Yes No Yes |
Yes Yes Yes No |
Yes No No Yes |
No Yes Yes No |
Yes No Yes No |
Yes Yes No No |
No No Yes No |
No Yes No No |
Yes No No No |
No No No No |
**HYPERTENSIVE SUBJECTS ONLY
Notes on use of table
- Choose the table for men or women
- Identify the correct column for smoking, hypertension and diabetes
- In normotensive subjects assume LVH absent. In those with hypertension, LVH is diagnosed by ECG showing increased voltage and flat or inverted T waves in the left precordial leads. If no ECG is available, assume LVH is absent.
- Identify the row showing the age of the subject
- Read off the cholesterol concentration at the intersection of the
appropriate column and row:
- If there is no entry, cholesterol need not be measured
- If there is an entry, measure serum cholesterol
- If the average cholesterol on repeated measurement is at or above the level shown, the CHD event risk is 3.0% per year consider treatment
The table can be used to look forward to need for measurement or treatment at an older age
LVH = left ventricular hypertrophy;
CHD = coronary heart disease;
ECG - electrocardiograph
- Do not use for decisions on secondary prevention : patients with
myocardial infarct, angina, peripheral vascular disease, or symptomatic
carotid disease already have high CHD risk
At this risk (3% events per year) treatment with a statin (but not necessarily other drug classes) is justifiable - Use the table after appropriate advice on smoking, diet, and control of systolic blood pressure to < 160 mm Hg
- Use the average of two or more cholesterol concentrations
- The table may underestimate CHD risk in some individuals:
- British Asians
- those with low HDL cholesterol
- those with very strong family history of premature CHD
- those with familial hyperlipidaemia
References:
Haq IU et al. Lancet 1995, 346: 1467-71.
Ramsay LE et al. Lancet 1996, 348: 387-88.
Haq IU et al. Clin Sci 1996, 91: 399-413.