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[Total risk for cardiovascular disease. At what point is medical prophylactic medication useful?]

H Gohlke1, C von Schacky

  • 1Klinische Kardiologie II, Herz-Zentrum Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany. helmut.gohlke@herzzentrum.de

Zeitschrift Fur Kardiologie
|November 1, 2005
PubMed

Insights

Calculating the number needed to treat (NNT) helps determine when to initiate medical treatment for coronary artery disease. An NNT below 200 is acceptable for primary prevention, guiding clinical decisions.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Decision Making

Context:

  • Coronary artery disease (CAD) poses significant epidemiological risk, yet individual cardiovascular events are infrequent.
  • Uncertainty exists regarding the optimal timing for initiating medical treatment in cardiovascular disease prevention.
  • Risk factor modification yields relative risk reduction, but absolute benefit depends on global risk assessment.

Purpose:

  • To explore the utility of global risk stratification and the number needed to treat (NNT) in guiding preventive medical interventions for cardiovascular disease.
  • To establish a framework for decision-making in primary prevention of cardiovascular events.

Summary:

  • Global cardiovascular risk can be estimated using various scoring systems.
  • The number needed to treat (NNT) quantifies the benefit of preventive strategies, calculated from global risk and expected relative risk reduction.
  • An NNT of less than 200 is considered acceptable for primary prevention, achievable with pharmacological strategies when 10-year global risk is 20% or higher.

Impact:

  • Risk stratification using NNT is crucial for informed decisions on initiating preventive treatments.
  • Age is a key predictor influencing treatment necessity at comparable risk factor levels.
  • This approach aids clinicians in optimizing preventive care for cardiovascular disease.

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