No abstract

mean excess rating increased from 89% (SD 52) in 1990 to 158% (SD 40) in 2002 (difference 69%, 95% confidence interval 41 to 97; P < 0.000, paired t test), but fell to 56% (SD 43) on treatment (102%, 79 to 126; P < 0.000), which was 33% lower (5 to 61; P = 0.022) than the original rating in 1990. CommentThe increase in mortality rating in the second survey, together with the substantial reduction in the excess applied to patients taking statins show that underwriters now assess risk more realistically and recognise that the prognosis for familial hypercholesterolaemia has improved with more effective treatment.2 Nevertheless variability in the rating applied was considerable, and patients could usefully be advised to shop around for the most competitive premium. The results of the survey, however, are reassuring and should encourage relatives of probands to be tested rather than being deterred by concerns about life assurance.We thank the life assurance companies for participating in the study.

Background: In many countries there is a gap between the clinical evidence for cardiovascular disease (CVD) prevention and implementation in clinical practice. Inadequate control of cardiovascular risk factors and underutilization of aspirin, statins, angiotensin converting enzyme inhibitors and b-blockers are well-established examples. The optimal approach to implementation of CVD prevention in clinical practice is still under debate. The screening and monitoring (SaM) approach is based on cyclic monitoring and individual treatment of patients with cardiovascular risk factors in the primary care setting. After achieving improvements in risk factor levels and in the use of preventive medications in a pilot study, it was decided to test the efficacy of this approach in a larger population at risk. Methods: Five primary care clinics adopted the SaM approach. A total of 1622 patients with established CVD, diabetes mellitus or hypertension were assessed by their family physicians for cardiovascular risk factors and use of medications for cardiovascular risk reduction. Interventions were made according to accepted clinical guidelines. Cardiovascular risk factor levels and the use of medications for CVD prevention were retrospectively analyzed. Results: The results demonstrated significant reductions in blood pressure, hemoglobin A 1c and low-density lipoprotein-cholesterol levels, as well as significant increases in the use of medications for CVD prevention. Conclusion: A systematic approach to CVD reduction, with an emphasis on multiple risk factor assessment and use of preventive medications in patients at cardiovascular risk, yielded significant improvements in measures of the quality of preventive care.