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Lipid lowering and coronary heart disease risk: how appropriate are the national guidelines?
Author(s) -
Forge Brett H,
Briganti Esther M
Publication year - 2001
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2001.tb143679.x
Subject(s) - medicine , framingham risk score , coronary heart disease , lipid profile , framingham heart study , coronary artery disease , heart disease , disease , intensive care medicine , cholesterol
Objective: To assess the effectiveness of current Australian guidelines for prescribing lipid‐lowering drugs in identifying high‐risk individuals in primary prevention of coronary heart disease. Design and setting: Coronary heart disease risk profiles were obtained for 280 consecutive patients dispensed lipid‐lowering drugs in rural Victoria. Their 10‐year absolute risk of coronary heart disease was determined using the Framingham formula. Patients were categorised according to their eligibility for lipid‐lowering drugs as defined by current Pharmaceutical Benefits Scheme (PBS) and National Heart Foundation (NHF) guidelines. Patients: Complete data were available for 230 patients dispensed lipid‐lowering drugs. Of these, the 138 patients (60%) with no history of vascular disease are the subjects of our study. Main outcome measures: Proportion of patients with various 10‐year coronary heart disease thresholds (15%, 20% and 30%), compared with their eligibility for lipid‐lowering drugs based on Australian PBS and NHF guidelines. Results: Twenty‐six per cent of patients with no history of vascular disease who are currently dispensed lipid‐lowering drugs do not fulfil PBS guidelines for treatment. Of patients conforming with PBS guidelines as suitable for lipid‐lowering drugs, 39% (95% CI, 30%–49%) had a 10‐year risk of coronary heart disease of less than 15%. A similar proportion (41% [95% CI, 32%–50%]) had a 10‐year risk of coronary heart disease of less than 15%, but were eligible for lipid‐lowering drugs according to NHF guidelines. Adherence to PBS and NHF guidelines in patients currently dispensed lipid‐lowering drugs would result in as many as 14% (95% CI, 8%–21%) and 7% (95% CI, 3%–12%) of patients, respectively, not being eligible for treatment, despite having a 10‐year risk of coronary heart disease greater than 15%. Conclusions: Australian guidelines for prescribing of lipid‐lowering drugs are poor discriminators of absolute risk of coronary heart disease in primary prevention. Strategies based on the continuous relationship between risk‐factor intensity and absolute coronary heart disease risk, such as the Framingham risk estimates, provide a more rational basis for formulating treatment guidelines.