Should treatment recommendations for lipid lowering drugs be based on absolute coronary risk or risk reduction?

doi:10.1136/bmj.320.7236.677

BMJ 2000;320:677-679 ( 11 March )

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Should treatment recommendations for lipid lowering drugs be based on absolute coronary risk or risk reduction?

Editorial by Jackson

S Ramachandran, senior registrar, chemical pathology ^a, J M French, research associate ^c, M P J Vanderpump, consultant endocrinologist ^d, P Croft, professor ^b, R H Neary, consultant, chemical pathology ^a.

^a Department of Clinical Biochemistry, North Staffordshire Hospital, Stoke on Trent ST4 7PA, ^b Department of Epidemiology, North Staffordshire Hospital, ^c Department of Medical Statistics, University of Newcastle, Newcastle upon Tyne NE2 4HH, ^d Department of Endocrinology, Royal Free Hospital, London NW3 2QG

Correspondence to: R H Neary nearrh@netscape.net

The first 150 words of the full text of this article appear below.

Current guidelines for prescribing lipid lowering drugs are based on an individual's risk of coronary heart disease ratherthan on the reduction in risk that treatment may bring. We reporta strategy for making treatment decisions that combines computerassisted calculation of absolute risk with an estimate of benefitto the patient fromtreatment.

Subjects, methods, and results

During a period of 14 months, 17 randomly selected general practices (63 practitioners) in north Staffordshire were askedto send to the department of clinical biochemistry their requestsfor coronary heart disease risk assessment on patients being consideredfor lipid lowering drug treatment.

Table Removed (Available Only in the Full Text)

We used the Framingham statistical model to estimate a patient's absolute risk of coronary heart disease over five years.The reduction in risk that treatment would bring over the nextfive years was calculated from the product of the absolute fiveyear risk and the risk reduction observed in clinical trials ormeta-analysis. The reduction in . . . [Full text of this article]

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