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Response

N. John Bosomworth
Canadian Family Physician July 2011, 57 (7) 761;
N. John Bosomworth
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Dr Dufour is entirely correct. If we follow only the Adult Treatment Panel III guidelines, 42.3% of adults between 35 and 70 years of age are candidates for statin therapy. If we add C-reactive protein testing, this increases to 52.6%; if we add additional low-density lipoprotein (LDL) triggers (LDL > 3.5 mmol/L), this jumps to 61.7%.1 The Canadian guidelines incorporate the latter 2 strategies. Currently, less than 50% of Adult Treatment Panel III–eligible patients are taking statins. As two-thirds of the benefit in cardiovascular events is seen with the initial statin dose, and as there is no good evidence for C-reactive protein use and LDL targets, compliance might be best served by evaluating risk and treating those with high scores with a mid-dose generic statin. This is almost sure to improve compliance, and we are much more likely to improve outcomes for high-risk patients in primary prevention. For patients who are happy to obsess about LDL levels, we always have guidelines to fall back on.

The calculator is meant as a decision aid for both guideline and “fire and forget” approaches. A recent revision includes numbers needed to treat, which might be useful for patient decisions.

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  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

Reference

  1. ↵
    1. Nanchen D,
    2. Pletcher MJ,
    3. Cornuz J,
    4. Marques-Vidal PM,
    5. Paccaud F,
    6. Waeber G,
    7. et al
    . Public health impact of statin prescribing strategies based on JUPITER. Prev Med 2011;52(2):159-63. Epub 2010 Dec 3.
    OpenUrlPubMed
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Canadian Family Physician: 57 (7)
Canadian Family Physician
Vol. 57, Issue 7
1 Jul 2011
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Canadian Family Physician Jul 2011, 57 (7) 761;

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Canadian Family Physician Jul 2011, 57 (7) 761;
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