Primary prevention drug therapy: Can it meet patients' requirements for reduced risk?
Primary prevention drug therapy: Can it meet patients' requirements for reduced risk?
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DOI：
10.1177/0272989x0202200411
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发表时间：
2002-07-01
影响因子：
3.6
通讯作者：
Naylor, CD
中科院分区：
文献类型：
--
作者：
Llewellyn-Thomas, HA;Paterson, JM;Naylor, CD
其目的是在一级预防中确定“所需风险降低”（ReqRR）大于降胆固醇药物或抗高血压药物所能提供的“可实现风险降低”（ARR）的患者。对66例高胆固醇血症（HC）和64例无症状性心血管疾病的高血压（HT）患者进行10年冠心病或卒中风险的个体化估计。这些估计值用于确定每个人的ReqRR的权衡任务。然后估计个体ARR（在HC患者中，假设总胆固醇/高密度脂蛋白比值降至5.0;在HT患者中，假设收缩压降至120 mmHg）。12例（18%）HC受试者和12例（19%）HT受试者将拒绝药物治疗，无论提供的风险降低如何。在其余患者中，15/54（28%; 95% C.I. 16-40%）HC和19/52（37%; 95% C.I.：24-51%的HT受试者是“过度需求者”，因为他们的ReqRR/ARR比率为1.5。可能有一个显着比例的患者的ReqRR是远远大于什么是可实现的，这意味着决策辅助工具可以帮助个人澄清偏好接受/拒绝药物治疗的心血管疾病的一级预防。
The objective was to identify, in primary prevention, patients whose "required risk reduction" (ReqRR) is greater than the "achievable risk reduction" (ARR) that cholesterol-lowering a or antihypertensive medication could provide. Individualized estimates of 10-year coronary heart disease or stroke risk were derived for 66 hypercholesterolemic (HC) and 64 hypertensive (HT) patients without symptomatic cardiovascular disease. These estimates were used in trade-off tasks identifying each individual's ReqRR. Then individual ARRs were estimated (in HC patients by assuming total cholesterol/high density lipoprotein ratio reductions to 5.0; in HT patients by assuming systolic blood pressure reductions to 120 mmHg). 12 (18%) HC and 12 (19%) HT subjects would refuse medication regardless of the risk reduction offered. Of the remaining patients, 15/54 (28%; 95% C.I. 16-40%) HC and 19/52 (37%; 95% C.I.: 24-51%) HT subjects were "over-requirers," in that their ReqRR/ARR ratio was 1.5. There may be a notable proportion of patients whose ReqRR is considerably greater than what is achievable, implying that decision aids may help individuals clarify preferences about accepting/refusing medication for the primary prevention of cardiovascular disease.