Wednesday, April 9, 2008

JAMA editorial: Eric Peterson and Tracy Wang on preventive cardiology
by Kelly Winget

In the April 9 issue of the Journal of American Medical Association, the DCRI's Eric Peterson, MD, MPH, and Tracy Wang, MD, MS, have an editorial on the current debate about when it is too soon to begin drug therapy for cardiovascular conditions to prevent future cardiac events.

Data from clinical studies have shown that lower levels of cholesterol, blood pressure and glucose correlate with less cardiovascular disease. And in patients who already have cardiovascular disease, data indicates that using statin drugs for intensive cholesterol treatment reduces future cardiac events such as heart attacks. As a result, treatment guidelines have set lower thresholds for when patients should consider taking some type of cardiovascular medication.

But there remain some questions about the long term benefits and risks of aggressive treatment and setting such low target levels to achieve through treatment.

As an intermediate solution, Drs. Peterson and Wang suggest that physicians recommend intensive cholesterol-lowering treatment with statin drugs for patients with diabetes, based on results from large, randomized clinical trials that indicate relatively few adverse effects or patient risks. But they say that more studies are needed on the benefits of intensive blood pressure treatment.

One recommendation in the editorial is for clinicians to provide better assistance to patients and help them more effectively modify their cardiovascular risk factors. Currently, only a third of patients with high blood pressure and high levels of cholesterol are meeting standard treatment goals. Drs. Peterson and Wang said clinicians will need to find new ways of engaging patients in their disease management.

To read the editorial, please visit http://jama.ama-assn.org/ and click on "The Great Debate of 2008 - How low to go in preventive cardiology?"