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CV guidelines should be based on absolute risk

By Nigel Praities

Guideline blood pressure and lipid targets are not evidence-based and GPs should use absolute cardiac risk to guide their treatment decisions, says a top epidemiologist.

The controversial recommendation came during the first-ever primary care focused session at the European Society of Cardiology in Munich.

Professor Arno Hoes, professor of clinical epidemiology at the University of Utrecht in the Netherlands and an ESC guideline author himself, said there were often confounding factors in clincial trials and so goals in guidelines were ‘not really evidence-based'.

'In practice, primary care physicians know that a patient won't stop smoking, so you have to go for blood pressure or lipids, or you know they will not increase their physical exercise or lose weight.

‘In my view absolute risk should be the target of the future, this way the difference is lowering risk rather than meeting targets for blood pressure or cholesterol,' he said.

Professor Hoes suggested an achieveable target in primary care could be reducing a patient's absolute 10-year risk of 5% or greater.

Professor Richard Hobbs, professor of general practice at the University of Birmingham, said going for one composite measure ‘seems sensible' but questioned whether it would work in clinical practice.

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