title: Conflicts and dilemmas in prevention of cardiovascular disease. The new, Norwegian guidelines--a new approach to risk management.
abstract: Prevention of cardiovascular disease (CVD) has been debated for many years, between an organ-specialist perspective versus a public health view. As an illustration, the Wonca Europe Council decided in 2004 to withdraw its support to the 2003 European Guidelines. This paper discusses the main sources of disagreement, most important the levels of risk when treatment should be offered. The Norwegian Guideline for primary prevention of CVD (2009) introduced a new principle of age-differentiated risk levels. Pharmacological treatment should be offered to all persons aged 40-49 years with 10-year mortality risk ≥ 1%, all persons aged 50-59 years at ≥ 5% risk, and all persons aged 60-69 years at ≥ 10% risk. Lower thresholds for younger persons are based on the fact that life years lost, will be considerable if drugs are prescribed only for risk levels above 5%. For persons aged 60-69 years, age is the dominant risk factor and the benefits of treatment are smaller. The implications of the recommendation are discussed, both at an individual and a societal level. Compared to the European 2007 guidelines, the total sum of life years gained is about the same, but the number of patients treated is considerably lower.
authors.affiliation: Department of General Practice, Institute for Health and Society, University of Oslo, Oslo, Norway. bjorn.gjelsvik@medisin.uio.no
authors.forename: Bjørn
authors.initials: B
authors.lastname: Gjelsvik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D009664:Norway; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*