Cost effective strategies for reducing coronary risk in primary care

BMJ 1995;311:573 (26 August)

Letters

Cost effective strategies for reducing coronary risk in primary care

EDITOR,--The implication of K Field and colleagues' paper seemsto be that the cost of screening in cardiovascular preventionis high in primary care, particularly when the screening isnot targeted at high risk patients.¹ I agree with this but disagreewith the model used in the paper to assess the cost effectivenessof reducing coronary risk. I think that the message to purchasersthat we should use lipid lowering treatment only in patientswith cholesterol concentrations above 9.5 mmol/l is dangerous.This is reminiscent of the nonsensical recommendation made bythe Scottish Home and Health Department some years ago for acut off of 10 mmol/l.

It is naive to estimate benefits simply on the basis of totalcholesterol concentration, particularly when examining a populationof women. Up to a quarter of women aged 35 or more have a highhigh density lipoprotein cholesterol concentration, but manyof these . . . [Full text of this article]

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Relevant Article

Strategies for reducing coronary risk factors in primary care: which is most cost effective?: K Field, M Thorogood, C Silagy, C Normand, C O'Neill, and J Muir
BMJ 1995 310: 1109-1112. [Abstract] [Full Text]

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