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[Do the patients we treat with hypolipemic drugs have a coronary risk?]
J Vilaseca Canais1, C Buxeda Mestres, C Cámara Contreras
1Unidad Docente de MFyC, ABS Sant Josep, CAP Just Oliveras L' Hospitalet de Llobregat, Barcelona.
Insights
Assessing coronary risk (CR) in patients on lipid-lowering drugs revealed significant variation, with 16-38.3% deemed high risk. Including specific conditions increased this to over 73%, highlighting the need for accurate CR assessment in treatment decisions.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacotherapy
Background:
- Lipid-lowering drugs are crucial for managing cardiovascular disease.
- Accurate assessment of coronary risk (CR) is essential for appropriate treatment initiation and management.
- Multiple methods exist for calculating CR, potentially leading to variations in patient stratification.
Purpose of the Study:
- To evaluate the appropriateness of lipid-lowering drug treatment by comparing four different coronary risk (CR) calculation methods.
- To determine the proportion of patients on lipid-lowering therapy who are classified as high CR by various assessment tools.
Main Methods:
- A crossover study design was employed in a primary care setting.
- Patients receiving lipid-lowering drugs were assessed using four CR calculation methods: simplified Framingham, Dundee-Risk-Disk, modified Sheffield, and Cardiovascular Risk in Primary Care (CVRap).
- Data from 186 patients were analyzed after excluding those with secondary prevention, incorrect age, or missing pre-treatment cholesterol data.
Main Results:
- Coronary risk (CR) varied significantly by method, with 38.3% high risk by Framingham, 25.6% by CVRap, 18.7% by Dundee-Risk-Disk, and 16% by modified Sheffield.
- Adequate concordance was observed between the different CR assessment methods.
- The study included 186 patients (137 men, 193 women, average age 58.8) on statins, clofibrates, resins, or other lipid-lowering drugs.
Conclusions:
- A substantial proportion of patients (16-38.3%) receiving lipid-lowering drugs are classified as high coronary risk (CR).
- When patients with severe hypercholesterolemia and diabetics with hypercholesterolemia are included, the high CR percentage increases significantly, ranging from 59.7% to 73.3%.
- These findings underscore the importance of utilizing appropriate CR assessment tools to ensure the efficacy and appropriateness of lipid-lowering drug treatments.
Objective:
To study the appropriateness of lipid-lowering drugs treatment through four methods of calculating coronary risk (CR).
Design:
Crossover study.
Setting:
Primary care centre.
Patients:
All patients receiving lipid-lowering drugs.
Measurements And Main Results:
CR was determined for individuals with application criteria by four methods: the simplified Framingham, Dundee-Risk-Disk, modified Sheffield label and Cardiovascular Risk in Primary Care (CVRap). 330 patients followed the treatment, 137 men and 193 women with an average age of 58.8 (SD 10.2). 54.2% received statims, 28.5% clofibrates, 13.6% resins and 3.6% other drugs. 186 patients were included, 75 (22.7%) being excluded because of secondary prevention and the rest because they were not the right age or had no cholesterol data prior to treatment. 38.3% were at high CR according to Framingham, 25.6% according to CVRap, 18.7% according to Dundee-Risk-Disk and 16% according to modified Sheffield. Concordance between these methods was adequate.
Conclusions:
Between 16% and 38.3% of the individuals treated are at high CR. If we also include patients with severe Hypercholesterolaemia and diabetics with Hypercholesterolaemia, this percentage rises to 59.7-73.3%, according to the CR assessment method used.