Document Detail


Lipid lowering and coronary heart disease risk: how appropriate are the national guidelines?
MedLine Citation:
PMID:  11758075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the effectiveness of current Australian guidelines for prescribing lipid-lowering drugs in identifying high-risk individuals in primary prevention of coronary heart disease. DESIGN AND SETTING: Coronary heart disease risk profiles were obtained for 280 consecutive patients dispensed lipid-lowering drugs in rural Victoria. Their 10-year absolute risk of coronary heart disease was determined using the Framingham formula. Patients were categorised according to their eligibility for lipid-lowering drugs as defined by current Pharmaceutical Benefits Scheme (PBS) and National Heart Foundation (NHF) guidelines. Patients: Complete data were available for 230 patients dispensed lipid-lowering drugs. Of these, the 138 patients (60%) with no history of vascular disease are the subjects of our study. MAIN OUTCOME MEASURES: Proportion of patients with various 10-year coronary heart disease thresholds (15%, 20% and 30%), compared with their eligibility for lipid-lowering drugs based on Australian PBS and NHF guidelines. RESULTS: Twenty-six per cent of patients with no history of vascular disease who are currently dispensed lipid-lowering drugs do not fulfil PBS guidelines for treatment. Of patients conforming with PBS guidelines as suitable for lipid-lowering drugs, 39% (95% CI, 30%-49%) had a 10-year risk of coronary heart disease of less than 15%. A similar proportion (41% [95% CI, 32%-50%]) had a 10-year risk of coronary heart disease of less than 15%, but were eligible for lipid-lowering drugs according to NHF guidelines. Adherence to PBS and NHF guidelines in patients currently dispensed lipid-lowering drugs would result in as many as 14% (95% CI, 8%-21%) and 7% (95% CI, 3%-12%) of patients, respectively, not being eligible for treatment, despite having a 10-year risk of coronary heart disease greater than 15%. CONCLUSIONS: Australian guidelines for prescribing of lipid-lowering drugs are poor discriminators of absolute risk of coronary heart disease in primary prevention. Strategies based on the continuous relationship between risk-factor intensity and absolute coronary heart disease risk, such as the Framingham risk estimates, provide a more rational basis for formulating treatment guidelines.
Authors:
B H Forge; E M Briganti
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  175     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-12-06     Completed Date:  2001-12-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  471-5     Citation Subset:  IM    
Affiliation:
West Gippsland Hospital, Warragul, VIC. bforge@absoluterisk.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antilipemic Agents / economics,  therapeutic use*
Australia
Coronary Disease / prevention & control*
Cost-Benefit Analysis
Female
Humans
Hypercholesterolemia / drug therapy*
Logistic Models
Male
Middle Aged
Practice Guidelines as Topic / standards*
Risk
Victoria
Chemical
Reg. No./Substance:
0/Antilipemic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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