Primary prevention drug therapy: can it meet patients' requirements for reduced risk?
The objective was to identify, in primary prevention, patients whose "required risk reduction" (ReqRR) is greater than the "achievable risk reduction" (ARR) that cholesterol-lowering or antihypertensive medication could provide. Individualized estimates of 10-year coronary heart disease or stroke risk were derived for 66 hypercholesterolemic (HC) and 64 hypertensive (HT) patients without symptomatic cardiovascular disease. These estimates were used in trade-off tasks identifying each individual's ReqRR. Then individual ARRs were estimated (in HC patients by assuming total cholesterol/high density lipoprotein ratio reductions to 5.0; in HT patients by assuming systolic blood pressure reductions to 120 mmHg). 12 (18%) HC and 12 (19%) HT subjects would refuse medication regardless of the risk reduction offered. Of the remaining patients, 15/54 (28%; 95% C.I.:16-40%) HC and 19/52 (37%; 95% C.I: 24-51%) HT subjects were "over-requirers," in that their ReqRR/ARR ratio was 1.5. There maybe a notable proportion of patients whose ReqRR is considerably greater than what is achievable, implying that decision aids may help individuals clarify preferences about accepting/refusing medication for the primary prevention of cardiovascular disease.
Llewellyn-Thomas
Hilary A
HA
Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755-3863, USA.
Paterson
J Michael
JM
Carter
Judy A
JA
Basinsk
Antoni
A
Myers
Martin G
MG
Hardacre
Gordon D
GD
Dunn
Earl V
EV
D'Agostino
Ralph B
RB
Wolf
Philip A
PA
Naylor
C David
CD
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D003657:Decision Making; D004338:Drug Combinations; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
D004338:Drug Combinations