Intended for healthcare professionals

Research

Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38849.487546.DE (Published 15 June 2006) Cite this as: BMJ 2006;332:1419

New Zealand Guidelines are Unworkable in Real Life

The authors' enthusiasm for the New Zealand Guidelines on
Cardiovascular Risk Assessment and management is misplaced. They are
unworkable in real life and hence little used by most New Zealand general
practitioners. The reason for this is simple: They rely on absolute risk
assessment. Absolute risk for cardiovascular disease inevitably rises as
one ages and in the elderly is uniformly high. If one uses the guidelines
one would recommend the use of statins and antihypertensives to veirtually
all elderly patients. This is nonsensical as the benefits accrued to a
healthy 80 year old put onto these drugs is minute (if present at all!)
The perils of polypharmacy in the elderly seem to have been forgotten by
enthusiasts for these guidelines.

A far more logical approach and one most working general
practitioners use is to ask what benefit in terms of adding years of life
will using these medications bring to a particular patient. This approach
has been modelled by Ulrich et al in the BMJ, 2000;320:1134-40 article
"What is the optimal age for starting lipid lowering treatment: A
mathematical model. This model clearly shows that use of guidelines based
on absolute risk is not effective as it invariable leads to overtreatment
of the elderly with little benefit and undertreatment of younger patients.

Competing interests:
None declared

Competing interests: No competing interests

20 July 2006
Paul A Corwin
general practitioner and Senior Lecturer
Christchurch School of Medicine, PO Box 4345, Christchurch, NZ