Norway's new principles for primary prevention of cardiovascular disease: age differentiated risk thresholds

Norheim, Ole Frithjof; Gjelsvik, Bjørn; Klemsdal, Tor Ole; Madsen, Steinar; Meland, Eivind; Narvesen, Stein; Negård, Anne; Njølstad, Inger; Tonstad, Serena; Ulvin, Frøydis; Wisløff, Torbjørn

doi:10.1136/bmj.d3626

Cited by 16 publications

(12 citation statements)

References 12 publications

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“…The latter contained advice on lifestyle changes and principles of pharmacological prevention. They also included a risk chart (NORRISK) for ten-year cardiovascular mortality risk for persons aged 40 -70 years (2,3), and recommended agespecific thresholds for pharmacological intervention (4).…”

mentioning

confidence: 99%

Nye retningslinjer for forebygging av hjerte- og karsykdom

Klemsdal¹,

Gjelsvik²,

Elling³

et al. 2017

Tidsskriftet

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mentioning

confidence: 99%

Nye retningslinjer for forebygging av hjerte- og karsykdom

Klemsdal¹,

Gjelsvik²,

Elling³

et al. 2017

Tidsskriftet

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“…Dette gjør at det vesentlig er personer i øverste del av aldersintervallene som vil få risiko over tiltaksgrensen. Dette kan ses på som en svakhet ved de nye retningslinjene, og faggruppen bak retningslinjene har også uttalt at man i praksis bør interpolere intervensjonsgrensen når alderen er like over eller under en alderskategori (8).…”

Section: Diskusjonunclassified

Kan forebygge tidlig død

Alm

Warmbrodt²,

Klemsdal³

2012

Sykepleien

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“…[3][4][5][6] Because the prevalence and incidence of cardiovascular disease (CVD) increases exponentially with age, [7][8][9] some have suggested that preventive treatment be offered to everyone over a specified age without measuring other risk factors, 10 but others emphasize the need for risk stratification in old age. 11,12 Recently, the Leiden 85-plus Study (and others) showed that homocysteine is predictive of cardiovascular events in old age. [13][14][15][16][17][18] Because risk predictors are clinically meaningful only when effective preventive treatment is available, 19 which treatment possibilities exist (and are appropriate) for older persons with high homocysteine to lower their cardiovascular risk needs to be established.…”

mentioning

confidence: 99%

Homocysteine Levels and Treatment Effect in the Prospective Study of Pravastatin in the Elderly at Risk

Drewes

Poortvliet

Blom

et al. 2014

J American Geriatrics Society

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ObjectivesTo assess the effect of preventive pravastatin treatment on coronary heart disease (CHD) morbidity and mortality in older persons at risk for cardiovascular disease (CVD), stratified according to plasma levels of homocysteine.DesignA post hoc subanalysis in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), started in 1997, which is a double-blind, randomized, placebo-controlled trial with a mean follow-up of 3.2 years.SettingPrimary care setting in two of the three PROSPER study sites (Netherlands and Scotland).ParticipantsIndividuals (n = 3,522, aged 70–82, 1,765 male) with a history of or risk factors for CVD were ranked in three groups depending on baseline homocysteine level, sex, and study site.InterventionPravastatin (40 mg) versus placebo.MeasurementsFatal and nonfatal CHD and mortality.ResultsIn the placebo group, participants with a high homocysteine level (n = 588) had a 1.8 higher risk (95% confidence interval (CI) = 1.2–2.5, P = .001) of fatal and nonfatal CHD than those with a low homocysteine level (n = 597). The absolute risk reduction in fatal and nonfatal CHD with pravastatin treatment was 1.6% (95% CI = −1.6 to 4.7%) in the low homocysteine group and 6.7% (95% CI = 2.7–10.7%) in the high homocysteine group (difference 5.2%, 95% CI = 0.11–10.3, P = .046). Therefore, the number needed to treat (NNT) with pravastatin for 3.2 years for benefit related to fatal and nonfatal CHD events was 14.8 (95% CI = 9.3–36.6) for high homocysteine and 64.5 (95% CI = 21.4–∞) for low homocysteine.ConclusionIn older persons at risk of CVD, those with high homocysteine are at highest risk for fatal and nonfatal CHD. With pravastatin treatment, this group has the highest absolute risk reduction and the lowest NNT to prevent fatal and nonfatal CHD.

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Norway's new principles for primary prevention of cardiovascular disease: age differentiated risk thresholds

Cited by 16 publications

References 12 publications

Nye retningslinjer for forebygging av hjerte- og karsykdom

Nye retningslinjer for forebygging av hjerte- og karsykdom

Kan forebygge tidlig død

Homocysteine Levels and Treatment Effect in the Prospective Study of Pravastatin in the Elderly at Risk

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