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Læknablaðið - 15.06.2006, Qupperneq 38

Læknablaðið - 15.06.2006, Qupperneq 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
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