At 07/03/2005, Ronán Conroy wrote:
>Paul Glasziou wrote:
>
>>Jon,
>>We develop a risk stratification tool within the LIPID trial cohort
>>(9,014
>>randomised patients, all post-MI).
>>Much the same risk factors as pre-event/pre-treatment.
>>Reference below.
>>Paul Glasziou
>
>I'd add to Paul's email that we looked at this in the SCORE project, and
>one of the reasons we didn't publish a risk function for those with
>established disease was that there was no useful group of either high or
>low risk people that we could identify. While some sort of risk
>evaluation may be useful information, there's no rationale that we could
>see for stratifying or rationing interventions based on risk. This has
>carried over into the European Task Force recommendations. Previous
>versions included charts for those with established CHD (though this was
>based on Framingham's LVH definition, which was a fudge). The current
>version recommends that you treat them all as high risk.
Ronan,
Good point - even our lowest risk level in the non-statin group was 6.4%
CHD events per 5 years (and many would have been on aspirin and beta-blockers).
If we considered all of CVD events, this would probably make the "green"
zone in the NZ risk charts in the back of Clinical Evidence.
But clearly most post-event patients are at "high risk", which was the
point of the LIPID trial: even those post-MI patients with "normal
cholesterol (4.0-6.5) benefited from cholesterol reduction. For those how
can't think in terms of risk, I sometimes suggest that the MI has
identified these "normal range" folk as cholesterol sensitive.
Paul Glasziou
>--
>
>Ronan M Conroy ([log in to unmask])
>Senior Lecturer in Biostatistics
>Royal College of Surgeons
>Dublin 2, Ireland
>+353 1 402 2431 (fax 2764)
>--------------------
>Just say no to drug reps
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Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055 www.cebm.net
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