Age-neutral guidelines for the primary prevention of cardiovascular disease.
Use of common guidelines for primary prevention of cardiovascular events based on 10-year risk results in undertreatment of younger individuals, especially women, since age and sex are major determinants of global risk. Women in their late 40s have a 10-year risk lower than the 10% threshold used for cholesterol-lowering treatment even in the presence of marked elevations of blood pressure or cholesterol. Removal of age from risk algorithms and use of lifetime global risk to treat individuals according to the degree of their modifiable risk factors rather than demographics has been proposed. Initiation of therapy at younger ages, aiming at "primordial" prevention of atherosclerotic disease rather than focusing on cardiovascular events, will result in saving more quality-adjusted life-years. Generic medications can be obtained at an affordable cost, and concerns about long-term safety and efficacy can be tested in a clinical trial of younger individuals at low 10-year risk but high lifetime risk.
Kostis
William J
WJ
Massachusetts General Hospital, Boston, 02114, USA. wkostis@partners.org
Kostis
John B
JB
D000328:Adult; D000367:Age Factors; D000465:Algorithms; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors