title: What to say and how to say it: effective communication for cardiovascular disease prevention.
abstract: Current guidelines for cholesterol treatment emphasize the importance of engaging patients in a risk-benefit discussion prior to initiating statin therapy.
  
  
  
  Although current risk prediction algorithms are well defined, there is less data on how to communicate with patients about cardiovascular disease risk, benefits of treatment, and possible adverse effects.
  
  
  
  We propose a four-part model for effective shared decision-making: 1) Assessing patient priorities, perceived risk, and prior experience with cardiovascular risk reduction; 2) Arriving at a recommendation for therapy based on the patient's risk of disease, guideline recommendations, new clinical trial data, and patient preferences; 3) Communicating this recommendation along with risks, benefits, and alternatives to therapy following best practices for discussing numeric risk; and 4) Arriving at a shared decision with the patient with ongoing reassessment as risk factors and patient priorities change.
authors.affiliation: aDivision of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina bDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois cDivision of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Stone
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D000066491:Clinical Decision-Making / Q000941:ethics; D003142:Communication; D003657:Decision Making; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010358:Patient Participation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D035501:Uncertainty
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors