Intended for healthcare professionals


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

BMJ 2006; 332 doi: (Published 15 June 2006) Cite this as: BMJ 2006;332:1419

Wanted: More Subgroup Analyses and NNH

As a member of two subgroups (women and everyone over 65), I don’t
see how treatment guidelines, even those from New Zealand, can help
doctors and, in turn, individuals make an informed decision about lifelong
statin therapy. How evidence-based are any of these guidelines, for
example, when only nine of the 20 lipid-lowering drug trials that included
women have published their results by gender? 1

Dr. Manuel and colleagues suggest that treatment recommendations be
focused on people at the highest risk of heart disease, but the trend in
the U.S. is to label everyone high risk if he or she is over 65 and has
high cholesterol. Unless treatment guidelines take into consideration the
number needed to harm, especially overall deaths, they are misleading to
doctors and to the general public.

The public purportedly should not know how its laws and sausage are
made. I would suggest treatment guidelines be added to the list.


1 Diagnosis and treatment of coronary heart disease in women:
systematic reviews of evidence on selected topics. U.S. Agency for
Healthcare Research & Quality publication No. 03-0037, May 2003.

Competing interests:
None declared

Competing interests: No competing interests

19 June 2006
Maryann Napoli
Consumer Advocate
Center for Medical Consumers, New York, New York ,10012, USA