Optimal age for starting lipid lowering treatment

doi:10.1136/bmj.321.7261.637

BMJ 2000;321:637 ( 9 September )

Letters

Optimal age for starting lipid lowering treatment

A 10 year risk of 30% should be used

It is more efficient to screen and treat elderly people

Adjusted data do not justify a lower optimal age

Authors' reply

A 10 year risk of 30% should be used

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

EDITOR $---$ Ulrich et al have bravely attempted to tackle a problem that has been quietly sidestepped for some time $---$ namely, thatlipid lowering does not (as far as we are aware) prevent coronaryheart disease, it merely postpones it.¹ The concept of assessingtreatment in terms of "event free life years gained" is a usefulone, but using a risk calculator to estimate potential benefitis fraught withdifficulty.

The authors base their calculation on the Framingham equation, in common with most coronary risk calculators, and have madeone particularly common but incorrect assumption regarding age.With the publication of the Framingham equation, Anderson et alstated that the equation "may be used for estimating outcome probabilitiesover a range of 4 to 12 years for persons aged 30 to 74 years."²Quoting calculated risks for ages 15 to 94 is therefore inappropriate.To attempt to recalculate such risks using a pharmacologicallylowered cholesterol concentration . . . [Full text of this article]

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