Revised guidelines for cardiovascular risk management — time to stop medication? A practice-based intervention study

Duijn, Huug J van; Belo, Janneke N; Blom, Jeanet W.; Velberg, Irvine D; Assendelft, W.J.J.

doi:10.3399/bjgp11x578025

Cited by 22 publications

(21 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is comparable to a physician driven deprescribing study conducted by Garfinkel et al [6], in which 78 % of older patients had their statins ceased (this percentage reflects combined patient and primary care provider acceptance of recommendation from the study geriatrician). Similarly, a study by Van Duijin found that 94 % of patients with low cardiovascular risk advised to deprescribe their anti-hypertensive or statin medications decided to stop [30].…”

Section: Discussionmentioning

confidence: 95%

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

Reeve

Hilmer

et al. 2015

Int J Clin Pharm

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 95%

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

Reeve

Hilmer

et al. 2015

Int J Clin Pharm

View full text Add to dashboard Cite

show abstract

“…Plotting the population distributions of five groups with increasing median values of risk reveals that their normal distributions shift rightward. Although a study based on the recent Dutch guideline for cardiovascular risk management suggests over half of primary care patients may have insufficient indication for medication [156], a reduction of 10% in cholesterol levels in the entire population has been predicted to reduce coronary heart disease mortality by 20% [157]. …”

Section: Discussionmentioning

confidence: 99%

Evidence of Lifestyle Modification in the Management of Hypercholesterolemia

Mannu

Zaman²,

Gupta³

et al. 2013

Current Cardiology Reviews

View full text Add to dashboard Cite

Background:Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. The growth of ageing populations in developing countries with progressively urbanized lifestyles are major contributors. The key risk factors for CHD such as hypercholesterolemia, diabetes mellitus, and obesity are likely to increase in the future. These risk factors are modifiable through lifestyle. Objectives: To review current literature on the potential benefit of cholesterol lowering in CHD risk reduction with a particular focus on the evidence of non-pharmacological/lifestyle management of hypercholesterolemia. Methods:Medline/PubMed systematic search was conducted using a two-tier approach limited to all recent English language papers. Primary search was conducted using key words and phrases and all abstracts were subsequently screened and relevant papers were selected. The next tier of searching was conducted by (1) reviewing the citation lists of the selected papers and (2) by using PubMed weblink for related papers. Over 3600 reports were reviewed.Results:Target cholesterol levels set out in various guidelines could be achieved by lifestyle changes, including diet, weight reduction, and increased physical activity with the goal of reducing total cholesterol to <200 mg/dL and LDL-C <100mg/dL. Various dietary constituents such as green tea, plant sterols, soy protein have important influences on total cholesterol. Medical intervention should be reserved for those patients who have not reached this goal after 3 months of non-pharmacological approach. Conclusion:CHD remains as a leading cause of death worldwide and hypercholesterolemia is an important cause of CHD. Non-pharmacological methods provide initial as well as long-term measures to address this issue.

show abstract

“…Nonetheless, preventive cardiovascular medication is often prescribed and used by patients with lower levels of predicted CVD risk than the actual guideline thresholds, because recommendations for drug initiation have been revised after treatment has been started 7,8. Deprescribing these potentially inappropriate medications can reduce unnecessary adverse reactions in patients and undue medical costs.…”

Section: Introductionmentioning

confidence: 99%

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Luymes¹,

Boelhouwer²,

Poortvliet³

et al. 2017

PPA

View full text Add to dashboard Cite

BackgroundPatients with low cardiovascular disease (CVD) risk potentially use preventive cardiovascular medication unnecessarily. Our aim was to identify various viewpoints and beliefs concerning the preventive CVD management of patients with low CVD risk using preventive cardiovascular medication. Furthermore, we investigated whether certain viewpoints were related to a preference for deprescription or the continuation of preventive cardiovascular medication.MethodsIn 2015, we purposively sampled patients from the intervention arm of the Evaluating Cessation of STatins and Antihypertensive Treatment In primary Care (ECSTATIC) trial in the Netherlands for this study. Participants made Q-sorts by ranking 43 statements concerning preventive CVD management from “totally disagree” to “totally agree”. These Q-sorts were analyzed using PQMethod 2.35 software. A varimax procedure presented the distinguishing viewpoints that were favored by our participants. We used group discussion quotations to underline our findings. For validation purposes, we asked participants how well each viewpoint fitted them.ResultsOf 291 invited patients, 33 participated. Thirty-one Q-sorts were analyzed. The following three viewpoints were found: 1) a controlling viewpoint, in which patients held the belief that monitoring blood pressure and cholesterol levels is important (n=13, of which seven had their medication deprescribed and six continued their medication); 2) an autonomous viewpoint, in which patients showed a dislike of medication (n=8, of which seven had their medication deprescribed and one had it continued); and 3) an afraid viewpoint, in which patients were fearful of developing CVD (n=8, of which two had their medication deprescribed and six had it continued). Seventy-four percent of the participants believed that the viewpoint to which they were assigned was a good fit.ConclusionThree well-discriminating viewpoints about preventive CVD management were determined. Knowing and recognizing these viewpoints is effective for general practitioners when discussing the deprescribing of preventive cardiovascular medications with patients and may be used to promote implementation of deprescription.

show abstract

Revised guidelines for cardiovascular risk management — time to stop medication? A practice-based intervention study

Cited by 22 publications

References 11 publications

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

Evidence of Lifestyle Modification in the Management of Hypercholesterolemia

Understanding deprescribing of preventive cardiovascular medication: a Q-methodology study in patients

Contact Info

Product

Resources

About