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Comparison of current guidelines for primary prevention of coronary heart disease: risk assessment and lipid-lowering therapy.

Abstract：

OBJECTIVE:In primary prevention of atherosclerotic disease, it is difficult to decide when medical treatment should be initiated. The main goal of the study was to compare different guidelines for coronary heart disease (CHD) risk assessment and initiation of lipid-lowering therapy. DESIGN:Cross-sectional evaluation. SETTING:An outpatient lipid and diabetes clinic in a university hospital. PARTICIPANTS/METHODS:Risk factor data obtained on 100 consecutive patients (58 men and 42 women) without clinical evidence of cardiovascular disease were used to compare the Framingham risk equation, the U.S. National Cholesterol Education Program (Adult Treatment Panel III) (NCEP ATP III) guidelines, the joint European Societies guidelines, the joint British guidelines, the revised Sheffield table, and the Munster Heart Study calculator (PROCAM) CHD risk assessment and lipid-lowering therapy. RESULTS:Guidelines could be applied to different subsets of the cohort, ranging from 22% (PROCAM) to 95% of the cohort (revised Sheffield table). All guidelines (except PROCAM) could be applied to a total of 62 patients. Guidelines predicted > or =20% risk for developing CHD over 10 years in 53% (NCEP ATP III), 26% (European) and 32% (British), while Framingham predicted this risk level in 34%. CHD risk was estimated to be > or =3%/year in 5% according to Sheffield, while Framingham predicted this risk in 13%. Lipid-lowering drug therapy is recommended in 52% by NCEP ATP III, while European, British, and Sheffield guidelines recommend this in 26%, 35%, and 5%, respectively. CONCLUSIONS:Guidelines for assessing CHD risk and lipid-lowering therapy differ greatly. Therefore, these algorithms must be used with caution.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Broedl UC,Geiss HC,Parhofer KG

doi

10.1046/j.1525-1497.2003.20207.x

subject

Has Abstract

pub_date

2003-03-01 00:00:00

pages

190-5

issue

3

eissn

0884-8734

issn

1525-1497

pii

jgi20207

journal_volume

18

pub_type

杂志文章

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