Absolute risk tool vital with statins
Assessing absolute risk using tools such as Framingham is essential for deciding who should get statins, researchers conclude.
Their study, published online by the BMJ, found guidelines using absolute risk scores were far more efficient at targeting statins than those employing measures of relative risk such as US guidance.
Absolute risk assessment performed well despite concerns over the Framingham score, which as Pulse revealed last week is now to be adjusted by patient deprivation.
Study leader Dr Douglas Manuel, a scientist at the Institute for Clinical Evaluative Sciences in Toronto, Canada, said: 'We teach absolute risk assessment in medical school and then the thinking is typically dropped, especially in guidelines.'
Dr Manuel's study compared guidelines from around the world on managing cholesterol. The optional US guidelines treated 24.5 per cent of the population compared with 17.3 per cent for 2004 Joint British Societies guidelines, but both prevented a similar number of deaths.
New Zealand guidelines were the most efficient, avoiding nearly as many deaths while treating 12.9 per cent of people.
Professor Tom Fahey, professor of primary care medicine at the University of Dundee, wrote in an accompanying commentary: 'Explicit absolute risk assessment is an essential starting point when considering primary preventive.
'But uncritical application of Framingham may mislead and ongoing studies are needed to ensure CHD risk assessment is as accurate as possible.'