Intended for healthcare professionals

Rapid response to:

Education And Debate

Risk factor thresholds: their existence under scrutiny

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1570

Rapid Response:

what are we trying to prevent

When we talk about prevention and absoloute risk we have to consider
what we are actually trying to prevent. In the case of an MI for instance
are we simply trying to prevent the pathologic event (platelets sticking
to plaque in coronary artery) or are we trying to prevent the sequelae of
that pathologic event on the human organism involved (death, sadness of
loved ones and family, loss of income, decrease in quality of life- the
list goes on).

There is a very big distinction. If,for instance, we want to achieve
maximum reduction of pathologic events for a given amount of statins and
ace inhibitors then we should take everybody under the age of 75 off these
agents and put every over the age of 75 on them. If there wasn't enough
of the "given amount" to treat everybody over the age of 75 then we should
restrict the treatment to those at even higher risk, lets say those over
the age of 80, unless all ready in a rest home or hospital, as the younger
people in rest homes are still at high risk.

This would a much better "value for resourses" in terms of preventing
"pathologic events" than our current policy.

If as health proffesionals we are interested in reducing human
suffering of the affected individual and their family and friends then we
need to take quite a different approach.

Competing interests: No competing interests

04 July 2002
David Rillstone Robertson
Shirley Medical Centre ChCh New Zealand