Lipid-lowering for prevention of coronary heart disease : what policy now ?
1. Recent outcome trials suggest that lipid-lowering with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors is justifiable on risk-benefit grounds in subjects with serum cholesterol>5.5 mmol/l who have coronary heart disease, other forms of atherosclerotic vascular disease, or who are free of vascular disease but have a risk of major coronary events =1.5% per year.
Choice of an appropriate treatment policy will require (i) knowledge of the proportion of the population who will need treatment for secondary prevention, and (ii) targeting of treatment for primary prevention at a specified absolute risk of coronary heart disease events.
Selection of an appropriate coronary heart disease risk for primary prevention requires consideration of the number needed to be treated to prevent one coronary heart disease event, the proportion of the population requiring treatment, the cost-effectiveness of treatment and the total cost of treatment. 2. In a random stratified sample of subjects aged 35-69 years from the Health Survey for England 1993 we first examined the prevalence of subjects with cardiovascular disease and serum cholesterol>5.5 mmol/l who may be candidates for secondary prevention.
In those free of cardiovascular disease we then examined the prevalence of subjects with serum cholesterol>5.5mmol/l who had three different levels of coronary heart disease risk : coronary heart disease event rates of 4.5% per year, 3.0% per year and 1.5% per year. (...)
Mots-clés Pascal : Chimiothérapie, Hydroxymethylglutaryl-CoA reductase, Oxidoreductases, Enzyme, Inhibiteur enzyme, Coût, Royaume Uni, Europe, Prévention, Adulte, Homme, Hypolipémiant, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Hyperlipoprotéinémie, Vaisseau sanguin pathologie, Economie santé
Mots-clés Pascal anglais : Chemotherapy, Hydroxymethylglutaryl-CoA reductase, Oxidoreductases, Enzyme, Enzyme inhibitor, Costs, United Kingdom, Europe, Prevention, Adult, Human, Antilipemic agent, Cardiovascular disease, Coronary heart disease, Myocardial disease, Hyperlipoproteinemia, Vascular disease, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0508130
Code Inist : 002B02N. Création : 10/04/1997.