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

Author

Listed:
  • 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)

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.

Suggested Citation

  • 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 & C. David Naylor, 2002. "Primary Prevention Drug Therapy: Can It Meet Patients’ Requirements for Reduced Risk?," Medical Decision Making, , vol. 22(4), pages 326-339, August.
    • Handle: RePEc:sae:medema:v:22:y:2002:i:4:p:326-339
    DOI: 10.1177/0272989X0202200411
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    References listed on IDEAS

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    1. Llewellyn-Thomas, H. A. & McGreal, M. J. & Thiel, E. C. & Fine, S. & Erlichman, C., 1991. "Patients' willingness to enter clinical trials: Measuring the association with perceived benefit and preference for decision participation," Social Science & Medicine, Elsevier, vol. 32(1), pages 35-42, January.
    2. Torrance, George W., 1976. "Social preferences for health states: An empirical evaluation of three measurement techniques," Socio-Economic Planning Sciences, Elsevier, vol. 10(3), pages 129-136.
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