Cardiovascular Disease Prevention: Matching Evidence-Based Algorithms With Individualized Care

Abstract

The appropriate use of statins in primary prevention remains a matter of debate. Although statins reduce cardiovascular events at all levels of baseline risk, they are associated with rare but important side effects including incident diabetes. Herein, we review strategies for statin allocation ranging from strict "evidence-based" adherence to randomized controlled clinical trial (RCT) entry criteria to more "personalized" risk assessment using high-sensitivity C-reactive protein (hsCRP), coronary artery calcification (CAC), or genetic testing. Current guidelines advocate an unusual middle ground between an evidence-based approach and a personalized approach.

GPs’ Perceptions of Cardiovascular Risk and Views on Patient Compliance: A Qualitative Interview Study

“…Dyslipidaemia itself is not associated with symptoms, and the reduced blood lipids due to the effect of lipid-lowering drugs cannot be felt by the patient. The GP must consider the beneficial effect against the risk of side effects and take into account the patient's comedication, comorbidity, and life expectancy, as well as other patient factors, preferences, and the cost of the drug [ 13 , 14 ]. GP risk perception can be associated with a broad spectrum of personal variables such as personality, communication style, and previous experiences, as well as demographic and organisational characteristics of the practice.…”

Statins for primary prevention: identifying low-risk individuals

“…In fact, some have advocated treating 'all comers' with statins. 4 Several issues, however, should be consid ered before advocating the widespread use of statins in individuals at low risk, such as the feasibility, desirability, and costeffectiveness of such a strategy, and the quality of life for apparently healthy individuals who are pre scribed lifelong drug therapy. Also i mportant are potential adverse effects of statins.…”

“…2,5,6 We agree that statins are likely to be ben eficial to patients with low cardio vascular risk calculated using tradi tional riskassessmen t algorithms, such as the Framingham Risk Score and the SCORE (Systematic COronar y Risk Estimation) charts. 4 However, additional riskstratificatio n options are needed to guide the use of statins in lowrisk individ uals. Data from the JUPITER trial 7 showed…”