Should treatment recommendations for lipid lowering drugs be based on absolute coronary risk or risk reduction

Editorial by Jackson Current guidelines for prescribing lipid lowering drugs are based on an individual's risk of coronary heart disease rather than on the reduction in risk that treatment may bring. We report a strategy for making treatment decisions that combines computer assisted calculation of absolute risk with an estimate of benefit to the patient from treatment. During a period of 14 months, 17 randomly selected general practices (63 practitioners) in north Staffordshire were asked to send to the department of clinical biochemistry their requests for coronary heart disease risk assessment on patients being considered for lipid lowering drug treatment. Coronary risk factors in patients being considered for lipid lowering drugs. Values are means (SD) We used the Framingham statistical model to estimate a patient's absolute risk of coronary heart disease over five years. The reduction in risk that treatment would bring over the next five years was calculated from the product of the absolute five …