Coronary heart disease (CHD) is caused by the narrowing of the coronary arteries due to atherosclerosis, which leads to angina. There are 2.3 million people living with CHD in the UK – over 1.4 million men and 850,000 women. The majority of deaths from CVD in the UK are attributed to CHD, which is responsible for around 73,000 deaths each year – an average of 200 people each day, or one every seven minutes.

Death rates from CHD are highest in Scotland and the north of England and lowest in the south of England. CHD treatment includes antiplatelets, statins, betablockers, nitrates, ACE inhibitors, angiotensin II receptor antagonists, calcium channel blockers and diuretics.

Antiplatelets

Antiplatelet treatment includes low-dose aspirin, clopidogrel, ticagrelor and prasugrel. An MUR is an opportunity to check patient understanding and adherence to prescribed treatments.

It is worthwhile checking if patients are taking aspirin after food and whether they may be experiencing any gastric adverse effects. Clopidogrel may commonly cause bruising or nose bleeds.

Statins

Statin treatment can be prescribed as primary prevention to patients with greater than 10 per cent CVD risk based on the QRISK 2 assessment tool. Atorvastatin 20mg is the statin offered unless the patient is committed to altering their lifestyle to reduce the CVD risk to less than 10 per cent.

Other statins used include simvastatin, pravastatin and rosuvastatin. Side effects commonly caused by statins include muscular aches – something which can be explored with the pharmacist in an MUR. Statins (except atorvastatin) are taken at night because cholesterol synthesis is greatest at this time.