title: Primary prevention drug therapy: can it meet patients' requirements for reduced risk?
abstract: 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.
authors.affiliation: Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755-3863, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.forename: Judy A
authors.initials: JA
authors.lastname: Carter
authors.forename: Antoni
authors.initials: A
authors.lastname: Basinsk
authors.forename: Martin G
authors.initials: MG
authors.lastname: Myers
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Hardacre
authors.forename: Earl V
authors.initials: EV
authors.lastname: Dunn
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Philip A
authors.initials: PA
authors.lastname: Wolf
authors.forename: C David
authors.initials: CD
authors.lastname: Naylor
mesh_terms: 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
chemical_list: D004338:Drug Combinations