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Cholesterol and coronary heart disease. The importance of patient-specific attributable risk
1Department of Medicine, Dartmouth-Hitchock Medical Center, Hanover, NH.
Insights
Understanding hypercholesterolemia treatment benefits requires practical attributable risk, not just relative risks. This approach offers a more realistic estimate of potential benefits for individual patients.
Area of Science:
- Cardiology
- Clinical Epidemiology
- Public Health
Background:
- The clinical utility of treating hypercholesterolemia is debated, partly due to the focus on relative risk measures in research.
- Risk ratio is commonly reported, but clinicians need to understand the absolute magnitude of risk reduction.
Purpose of the Study:
- To clarify the interpretation of risk measures in hypercholesterolemia management.
- To introduce practical attributable risk as a more clinically relevant metric.
- To analyze risk reduction strategies for diverse patient subgroups.
Main Methods:
- Literature review on hypercholesterolemia treatment.
- Calculation and comparison of risk ratio, attributable risk, and practical attributable risk.
- Analysis of risk measures across patient demographics (age, sex).
Main Results:
- Attributable risk can overestimate benefits because maximum risk reduction is seldom achieved.
- Practical attributable risk provides a more realistic estimation of potential benefits.
- Risk measures vary significantly across different patient subgroups.
Conclusions:
- Practical attributable risk is a more meaningful measure for clinicians assessing hypercholesterolemia treatment.
- Risk communication should be tailored to patient-specific contexts and subgroups.
- This approach aids in more informed clinical decision-making for hypercholesterolemia.
Abstract:
The value of treating hypercholesterolemia remains controversial despite extensive investigation, in part because of the research orientation of much of the relevant literature. Most published studies report relative measures of risks such as the risk ratio. However, clinicians are concerned with the magnitude of risk, or attributable risk, the difference in risk in those with highest and lowest serum cholesterol levels. Since maximum risk modification is rarely achieved, the attributable risk often overstates the potential benefit of risk factor reduction. A variant of the attributable risk, the practical attributable risk, gives a more realistic estimate of potential benefit. Since clinicians treat individuals and not populations, these measures of risk are most useful if reported for subgroups of patients (eg, men and women, as well as those of varying age). To illustrate these concepts, we review the literature on hypercholesterolemia, report the risk ratio, attributable risk, and practical attributable risk for important patient populations, and discuss the implications for clinical practice.