Læknablaðið - 15.06.2006, Page 38

KLÍNISKAR LEIÐBEININGAR / HJARTA- OG ÆÐASJÚKDÓMAR
SCORE-korti frá 2005 er markmið að ná kólest-
eróli niður fyrir 5 mmól/L og LDL-kólesteróli
niður fyrir 3 mmól/L.
Aldur
Almennt virðast leiðbeiningar forðast að taka á
þessu atriði umfram það sem fram kemur hér að
framan. Aldursviðmið hér virðast þó fara hækk-
andi og í Heart Protection Study virtust þátttak-
endur allt að 80 ára gamlir hafa gagn af meðferð
(2).
Mat á áhrifum leiðbeininganna
Reynt var að leggja mat á það hversu margir
myndu teljast í mikilli áhættu hér á landi sam-
kvæmt ofanskráðum tillögum. Tekið var mið af
gögnum Hjartaverndar fyrir karla og konur í ald-
urshópnum 35-67 ára frá árinu 2003 (tafla I).
Ef 10% áhætta er skilgreind sem mikil áhætta
myndu um það bil 14% einstaklinga í framan-
greindum aldurshópi lenda í þeim flokki þar sem
íhuga þyrfti kólesteróllækkandi lyfjameðferð. Sé
tekið mið af 50 ára og eldri myndu 60% karla og
um 9% kvenna teljast í mikilli áhættu samkvæmt
framangreindum viðmiðunargildum.
Þakkir
Hjartavernd fær þakkir fyrir að leggja til faralds-
fræðileg gögn sem íslenskt áhættumat er byggt á.
Sérstakar þakkir fær Thor Aspelund, tölfræðingur
Hjartaverndar, fyrir mikla og vandaða vinnu við
undirbúning gagna sem eru grundvöllur þessara
leiðbeininga.
Heimildir
1. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM,
Cobbe SM, et al. Pravastatin in elderly individuals at risk ot
vascular disease (PROSPER): a randomised controlled trial.
Lancet 2002; 360:1623-30.
2. MRC/BHF Heart Protection Study of cholesterol lowering
with simvastatin in 20,536 high-risk individuals: a randomised
placebo-controlled trial. Lancet 2002; 360: 7-22.
3. Major outcomes in moderately hypercholesterolemic,
hypertensive patients randomized to pravastatin vs usual
care: The Antihypertensive and Lipid-Lowering Treatment
to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002;
288:2998-3007.
4. Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G,
Caulfield M, et al. Prevention of coronary and stroke events
with atorvastatin in hypertensive patients who have average or
lower-than-average cholesterol concentrations, in the Anglo-
Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm
(ASCOT-LLA): a multicentre randomised controlled trial.
Lancet 2003; 361: 1149-58.
5. Cannon CP, Braunwaid E, McCabe CH, Rader DJ, Rouleau
JL, Belder R, et al. Intensive versus moderate lipid lowering
with statins after acute coronary syndromes. N Engl J Med
2004; 350:1495-504.
6. LaRosa JC, Grundy SM, Waters DD. Shear C, Barter P.
Fruchart JC, et al. Intensive lipid lowering with atorvastatin
in patients with stable coronary disease. N Engl J Med 2005;
352:1425-35.
7. Backer GD, Ambrosioni E, Borch-Johnsen K, Brotons
C, Cifkova R, Dallongeville J. European guidelines on
cardiovascular disease prevention in clinical practice. Eur
Heart J 2003; 24:1601-10.
8. Executive Summary of The Third Report of The National
Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, And Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III). JAMA
2001;285:2486-97.
9. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark
LT, Hunninghake DB, et al. Implications of recent clinical
trials for the National Cholesterol Education Program Adult
Treatment Panel III guidelines. Circulation 2004; 110:227-39.
10. Þorgeirsson G, Sigurðsson G, Sigurðsson J, Högnason J,
Sverrisson JÞ, Guðmundsson ÞV, et al. Meðferð við hárri
blóðfitu. Læknablaðið 1991; 77: 59-60.
11. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines
following guidelines? The methodological quality of clinical
practice guidelines in the peer-reviewed medical literature.
JAMA 1999; 281:1900-5.
12. Hasenfeld R, Shekelle PG. Is the methodological quality of
guidelines declining in the US? Comparison of the quality of
US Agency for Health Care Policy and Research (AHCPR)
guidelines with those published subsequently. Qual Saf Health
Care 2003; 12 ; 428-34.
13. Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice
guidelines developed by specialty societies: the need for a
critical appraisal. Lancet 2000; 355:103-6.
14. McKee M, Raine R. Choosing health? First choose your
philosophy. Lancet 2005; 365 : 369-71.
15. Conroy RM, Pyörala K, Fitzgerald AP, Sans S, Menotti
A, De Backer G, et al. Estimation of ten-year risk of fatal
cardiovascular disease in Europe: the SCORE project. Eur
Heart J 2003; 24: 987-1003.
16. Getz L, Sigurdsson JA, Hetlevik I, Kirkengen AL,
Romundstad S, Holmen J. Estimating the high risk group for
cardiovascular disease in the Norwegian HUNT 2 population
according to the 2003 European guidelines: modelling study.
BMJ 2005; 331:1551.
17. Wilhelmsen L, Wedel H, Conroy R, Fitzgerald T. The Swedish
SCORE chart for cardiovascular risk. Better possibilities for
prevention of cardiovascular diseases. Lakartidningen 2004;
101:1798-801.
18. Colhoun HM, Betteridge DJ, Durrington PN, Hitman
GA, Neil HA, Livingstone SJ, et al. Primary prevention of
cardiovascular disease with atorvastatin in type 2 diabetes in
the Collaborative Atorvastatin Diabetes Study (CARDS):
multicentre randomised placebo-controlled trial. Lancet 2004;
364: 685-96.
19. Olivarius Nde F. Diabetes care today: not everyone should
have intensive multipharmacological treatment. Scand J Prim
Health Care 2004; 22: 67-70.
20. Collins R, Armitage J, Parish S, Sleight P, Peto R. Effects of
cholesterol-lowering with simvastatin on stroke and other
major vascular events in 20536 people with cerebrovascular
disease or other high-risk conditions. Lancet 2004; 363: 757-
67.
21. Information frán Lakemedelsverket. Behandlingsrekommend-
ation. Prevention af aterosklerotisk hjártkarlsjukdom med lip-
idreglerande lákemedel; 2005:1: 9-19.
466 Læknablaðið 2006/92