Primary Prevention Drug Therapy: Can It Meet Patients’ Requirements for Reduced Risk?

Hilary A. Llewellyn-Thomas, J. Michael Paterson, Judy A. Carter, Antoni Basinski, Martin G. Myers, Gordon D. Hardacre, Earl V. Dunn, Ralph B. D’Agostino, Philip A. Wolf and C. David Naylor
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Hilary A. Llewellyn-Thomas: Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, Clinical Epidemiology Unit, Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada
J. Michael Paterson: Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada
Judy A. Carter: Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada
Antoni Basinski: Clinical Epidemiology Unit, Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Martin G. Myers: Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Gordon D. Hardacre: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Earl V. Dunn: Clinical Epidemiology Unit, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Ralph B. D’Agostino: Department of Mathematics, Boston University, Boston, Massachusetts
Philip A. Wolf: Departments of Neurology and Medicine, Boston University, Boston, Massachusetts
C. David Naylor: Clinical Epidemiology Unit, Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Science Centre, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Medical Decision Making, 2002, vol. 22, issue 4, 326-339

Abstract: 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 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.

Keywords: treatment preferences; hypertension; hypercholesterolemia; primary prevention; patients’ decision aids; trade-off technique (search for similar items in EconPapers)
Date: 2002
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:22:y:2002:i:4:p:326-339

DOI: 10.1177/0272989X0202200411

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