Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk

Jackson, Rod; Lawes, Carlene M.M.; Bennett, Derrick; Milne, Richard; Rodgers, Anthony

doi:10.1016/s0140-6736(05)17833-7

Cited by 324 publications

(253 citation statements)

References 62 publications

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“…In addition, treatment with lipid lowering mediations has been shown to be generally safe and effective. Serious side effects with medications like statins, including rhabdomyolysis are extremely rare [1,[5][6][7]. Finally, it has also been indicated that statins are cost-effective in primary prevention setting, particularly in high risk individuals [26].…”

Section: Discussionmentioning

confidence: 99%

“…This recommendation is primarily based on evidence suggesting that the higher the risk, the greater the benefit from interventions will be, thus justifying the need for the initiation of intensive risk factor management at higher levels of predicted CVD-related mortality risk [1,[4][5][6][7][8]. In particular, if the predicted 10-year risk of CVD-related mortality exceeds 5 %, individuals are classified as being at high cardiovascular risk and initiation of intensive risk factor management interventions is strongly recommended [1].…”

Section: Introductionmentioning

confidence: 99%

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Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

et al. 2014

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Document VersionPublisher's PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Competing non-cardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation (SCORE) model. In this study we assessed the impact of non-cardiovascular related deaths on the prognostic performance and yield of the SCORE model. 5,752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease (CVD) at baseline were included. A cause-specific hazards (CSH) CVD-related mortality prediction model that accounted for non-CVD-related deaths was developed. The prognostic performance of this model was then compared with a refitted SCORE model. During a median follow-up period of 12.5 years, 139 CVD and 495 non-CVD-related deaths were reported. Discriminatory performance was comparable between the models (Cindex = 0.64). The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation. The CSH model classified more non-events into the low risk group compared to the refitted SCORE model (n = 51), yet it was accompanied by a misclassification of six events into the low risk group. The refitted SCORE model classified more individuals as high risk. However, the potential overtreatment that may result from utilizing the refitted SCORE model, when compared with the CSH model, still falls within acceptable limits. Our findings do not support the incorporation of noncar...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

et al. 2014

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“…(21) Instead the WHO is advocating for an absolute risk assessment approach which aims to balance several CVD risk factors present in an individual whilst promoting a healthy lifestyle. (22) There is evidence to suggest that this approach could have an enormous impact on the treatment of heart disease (23) and would be a more cost-effective way of managing CVD. (21) Whilst focus on CVD has been minimal, the revised South African guideline for managing ischaemic stroke and transient ischaemic attack is a notable step.…”

Section: Risk Factors In South Africamentioning

confidence: 99%

A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response

Maredza

Hofman

Tollman

2017

SAHJ

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A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response and unhealthy diets. Even in rural SA, associated diffusion of urban behaviours is fostering the CVD epidemic. The United Nations projects that the percentage of population above 60 years will more than double between 1999 and 2050 in SA, with the burden due to CVD predicted to become the prime contributor to total morbidity and mortality in the over 50-year age group.(4) However, CVD is taking its toll even amongst the younger age groups, with deaths projected to increase by over 40% in the 35-to 64-year age group by 2030. This is further complicated by the growing number of HIV survivors, now estimated at 5.8% of the population older than 50 years. (5,6) This poses several challenges regarding the management of this emerging epidemic in the face of persisting undernutrition and Assuming a 4% rate of inflation, and a higher prevalence of CVD, the overall costs for CVD in 2010 would be more than double that 20 years ago. rIsk fActors In south AfrIcAThe major risk factors namely high blood pressure, tobacco use, high cholesterol, obesity, physical inactivity and unhealthy diets are increasingly prevalent in Africa, both in urban and rural settings.The national prevalence of hypertension in sub-Saharan African countries (SSA) ranges from about 4% to 10%, with SA at the upperend of this spectrum. The prevalence of hypertension amongst males and females in one rural Mpumalanga district was 44%and 42% respectively, (12) a figure much higher than that reported for other rural areas in SSA. Several disease specific guidelines for hypertension, chronic diseases of lifestyle (CDL) and for type 2 diabetes mellitus have been developed. (17,18) These guidelines provide information on the management and control and include interventions that have been shown to be cost-effective in middle and lower-income countries.However, available evidence suggests that primary prevention and management of common cardiac conditions is limited even with these guidelines "in place".Prioritisation of interventions for the primary prevention of chronic diseases is minimal. For example, the guideline on primary prevention of CDL lists a variety of interventions for management. Whilst focus on CVD has been minimal, the revised South African guideline for managing ischaemic stroke and transient ischaemic attack is a notable step. (24) This guideline puts forward a protocol for management that considers both the current epidemiological context and the strength of evidence of interventions for stroke care. The comprehensive plan that spans across all aspects of care including primary prevention, acute management, secondary prevention and rehabilitation, offers hope for mitigating the burden of disease due to stroke. ApproAchEs to prEVEntIonTwo approaches are conventionally advocated for CVD prevention. Population-wide approaches targeting the entire population and addressing the causes rather than the consequences; and those that target individual...

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“…Cardiovascular risk reduces rapidly after drug treatment is started. Clinical trials provide only short term answers and most treated subjects gain no benefit [43]. Unlike public health specialists, people want short term gain and few asymptomatic individuals are motivated to enter a life long intervention programme and even fewer are willing to take drug treatment.…”

Section: Concerns About Treatment Of Pre-hypertensionmentioning

confidence: 99%

Pre‐hypertension: how low to go and do drugs have a role?

McInnes

2012

Brit J Clinical Pharma

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People with pre-hypertension (high blood pressure but below the conventional threshold for intervention with antihypertensive drugs) undoubtedly have increased risk of cardiovascular and other complications. However, the vast majority has low absolute risk and whether treatment would be beneficial is uncertain. While pharmacotherapy has attractions from a public health perspective, clinicians and crucially those with pre-hypertension require robust evidence that drug treatment will lead to short term as well as long term gains. Any changes in recommendations should await adequately powered outcome studies which provide solid evidence of the magnitude of absolute risk reduction in treating pre-hypertension and assessment of the cost-effectiveness.

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Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk

Cited by 324 publications

References 62 publications

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response

Pre‐hypertension: how low to go and do drugs have a role?

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