Guidance 'exaggerates heart risk'

Roman Bystrianyk · medicine forum Guru Joined: 02 May 2005 Posts: 454

"Guidance 'exaggerates heart risk'", BBC News, June 24, 2005,
Link: http://news.bbc.co.uk/1/hi/health/4122692.stm

Doctors say thresholds for "normal" blood pressure and cholesterol
levels have been set so low healthy people might be put on unnecessary
medication.

The European Society of Cardiology drew up guidelines on cardiovascular
disease prevention in 2003.

However, GPs Steinar Westin and Iona Heath say under them as many as
90% of people over 50 could be labelled at risk, and end up on drugs.

The study is published in the British Medical Journal.

The GPs are concerned that many people might end up taking drugs which
would be of little benefit to them, but which are expensive and
associated with side effects.

However, the European Society of Cardiology said the concerns were
based on a "fundamental misunderstanding" of the purpose of the
guidance.

When the guidelines were applied to adults in Norway, 76% of the
popultion were defined as being at risk, including half of all
24-year-olds.

This is despite the average life expectancy in Norway being 78.9 years.

The researchers say the proportions are likely to be even higher if the
same thresholds are applied to the UK - where average life expectancy
is 78.1 years.

Psychological impact

Not only do the drugs potentially cause physical side effects, the
researchers are concerned there may be psychological effects from being
labelled as vulnerable to heart disease.

Writing in the BMJ, the researchers say: "We have far too little
understanding of the psychological impact and the wider health
consequences of being labelled at risk."

Doctors have raised concern about too many people being labelled as
being at risk before.

In 1999, more than 800 doctors, pharmacists and scientits from 42
countries signed an open letter expressing concern that World Health
Organization hypertension guidelines would result in increased use of
drugs at great expense and for little benefit.

The European Society of Cardiology issued a statement saying the
guidance was intended to help identify people who could benefit from
modifying their lifestyle to reduce risk - not to label people as sick.

The guidance did not recommend intensive therapy for people whose blood
pressure and cholesterol levels were higher than the threshold levels.

"In such subjects, simple lifestyle measures are the basis of
management with drugs held in reserve for only the highest risk
people."

The statement also questionned the merits of the Norway study, and said
other studies did not estimate that such a high number of people would
be defined as being at risk.

Cathy Ross, medical spokesperson for the British Heart Foundation,
said: "The limits suggested should act as guidelines in the assessment
of risk and should be used in combination with lifestyle advice.

"Furthermore, it is better for patients to be made aware of their risk,
and to take action to lower it, than to keep the threshold high simply
to avoid an unfortunate 'label'."

Ilena Rose · medicine forum Guru Joined: 05 May 2005 Posts: 813

Excellent article ... thanks Roman.

www.BreastImplantAwareness.org

riserman · medicine forum beginner Joined: 24 Jun 2005 Posts: 1

Roman,

Frustrating message from you. You say it's reported that too many people
are being treated for high cholesterol or high blood pressure, people
who do not need treatment at all. But you don't state the objective
numbers that define the thresholds at which medication is justified. To
be specific, at what cholesterol level and/or blood pressure level
should one start considering medicines to lower those levels?

Roman Bystrianyk wrote:

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