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CBC News
Last Updated Fri, 24 Jun 2005 16:33:12 EDT
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"Normal" blood pressure and cholesterol guidelines in Europe have been set
so low that over 90 per cent of people over 50 who are tested could end up
taking expensive drugs unnecessarily, a new editorial says.
The European Society of Cardiology's 2003 guidelines sets thresholds for
blood pressure and cholesterol, the two most common biological risk
factors
for cardiovascular disease.
INDEPTH: Heart Disease
Although the guidelines take into account other risk factors and recommend
lifestyle changes alongside drugs, the bottom line is doctors are expected
to inform patients of their higher cardiovascular risk, regardless of the
treatment approach, the authors said.
"In other words, a disease label is to be attached to the patient,"
general practitioners Steinar Westin of the Norwegian University of Science and
Technology and Iona Heath of the Caversham Group Practice in London write
in the June 25 issue of the British Medical Journal.
The pair outline six issues to consider before targeting drugs to such
large parts of the population:
When thresholds are set low, more people need to be treated before
benefits appear, while rates of side-effects stay about the same.
There is little direct evidence on the long-term effectiveness of the
treatments. Rather, data from short-term studies are simply extrapolated
over lifespans.
Side-effects tend to be under-reported for some cholesterol-lowering drugs
and heart medications. Little is known about the effects of combining several preventive drug
treatments at the same time. Doctors understand little about the psychological impact and wider health
consequences of being labelled "at risk."
The huge costs of prescribing drugs to so many people has the potential to
destabilize publicly funded health-care systems.
The pair suggest the Society take these issues into account as it
implements the guidelines. The guidelines recommend treating people with blood pressure of over
140/90 millimetres of mercury and serum cholesterol of 5 millimoles per litre,
with no correction for age.
Canadian guidelines for those 30 or older say medication may be needed if
total cholesterol is greater than 6.2 millimoles per litre.
In Canada, drugs are also suggested for those under 60 with a systolic
blood pressure of 140 or greater or diastolic at 90 or greater, combined with
other risk factors, according to the Heart and Stroke Foundation of
Canada's web site.
In a statement, the European Society of Cardiology said its guidelines are
meant to identify those who could be helped by lifestyle changes, not to
label people as sick. Drugs are only recommended for those at the highest
risk.
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