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Coronary risk estimates and decisions on lipid-lowering treatment in primary prevention: comparison between general

Federico Vancheri1, Lars-Erik Strender, Henry Montgomery

  • 1Internal Medicine, Ospedale S. Elia, Caltanissetta, Sicily, Italy. federico.vancheri@ki.se

European Journal of Internal Medicine
|September 29, 2009
PubMed

Insights

Cardiovascular risk assessment varies among general practitioners, internists, and cardiologists. These differences in risk estimation and lipid-lowering treatment recommendations can lead to inconsistent patient care.

Area of Science:

  • Cardiology
  • General Practice
  • Internal Medicine

Background:

  • Accurate quantitative assessment of absolute cardiovascular risk is crucial for effective primary prevention strategies.
  • Existing risk-scoring tools are available, but clinical risk estimation is often subjective.
  • Variability in risk assessment among different medical specialists may impact treatment decisions.

Purpose of the Study:

  • To compare quantitative cardiovascular risk estimates made by general practitioners (GPs), internists, and cardiologists.
  • To evaluate differences in recommendations for lipid-lowering treatment among these specialist groups for identical patient profiles.

Main Methods:

  • A mail survey was conducted using nine clinical vignettes (four high-risk, five low-risk based on Framingham equation).
  • The survey targeted 90 general practitioners, 90 internists, and 90 cardiologists in Sicily.
  • Participants estimated 10-year coronary risk and decided on initiating lipid-lowering treatment for each case.

Main Results:

  • Cardiologists provided significantly lower risk estimates compared to GPs and internists across most cases.
  • Internists were more likely to recommend lipid-lowering treatment (mean 0.68) than GPs (0.54) or cardiologists (0.57).
  • Treatment initiation exceeded 90% for risk estimates above 20% and fell below 50% for estimates below 20% across all groups; internists showed higher treatment rates even for risks below 20%.

Conclusions:

  • Significant discrepancies exist in cardiovascular risk perception and lipid-lowering treatment recommendations among GPs, internists, and cardiologists.
  • These variations can lead to potential over- or under-prescription of lipid-lowering medications.
  • Inconsistent clinical judgment among different physician categories may result in disparities in patient care.
Abstract

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