Dear Rod,
> If you take it far enough out then the NNT for death is 1 as
> everyone dies (although not all of CVD). Fortunately most CVD risk is
> reversible so one should calculate CVD risk over 5-10 years and decide
> whether treatment over this period is worth the benefits.
>
> best wishes Rod
>
I was interested in your comment that most CVD risk is reversible.
This seems counter-intuitive in relation to the fetal programming
literature/the Barker hypothesis and the Whitehall studies which
found that the classical risk factors only explained a relatively
small proportion of differences in CVD risk between social groups (in
that case grades of civil servant).
I have struggled with the problem of trying to work out the effect of
multiple interventions when there isn't trial data looking at them as
a whole (eg secondary prevention of IHD trials look at statins, ACE
inhibitors, beta blockers, aspirin as single interventions although
there are usually people on other interventions within the trial -
I'm not aware of there being data to say whether they're additive,
multiplicative or less than additive).
Is there any data to support the idea of CVD risk being mostly
reversible or is it predictions from Framingham on the assumption
that if you reduce cholesterol with a drug then that's the same as if
it was 'naturally' at the level you achieve with the drug?
Bruce
Bruce Guthrie,
MRC Training Fellow in Health Services Research,
Department of General Practice,
University of Edinburgh,
20 West Richmond Street,
Edinburgh EH8 9DX
Tel 0131 650 9237
e-mail [log in to unmask]
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