New cholesterol guidelines present need for shared decision-making

Dr. Victor Montori and two Mayo Clinic colleagues published a perspective piece in JAMA this week,Patient-Centered and Practical Application of New High Cholesterol Guidelines to Prevent Cardiovascular Disease.”

In it, they discuss the new American College of Cardiology/American Heart Association (ACC/AHA) guidelines for assessing cardiovascular disease and for treatment of blood cholesterol to reduce that risk.  They write that because the guidelines set an arbitrary 10-year risk threshold of 7.5% to begin statin drug treatment, and because “this threshold represents a value judgment about how much absolute cardiovascular disease risk reduction justifies the potential harms, costs, and inconveniences of taking statin medications,” they see a vital role for shared decision-making. There is not, they write, “a single right answer for all patients.” So they call for doctors to “engage the patient in shared decision making using evidence-based approaches.”

They demonstrated one way of doing that, displaying a video example of a patient decision aid on statin or aspirin choice.

Some journalists have told me that shared decision-making is a difficult concept for them to write about.  Maybe the use of a decision aid example, like this one, could help convey the concept, the need, and the prospects.

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Comments (2)

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Liz Scherer

February 7, 2014 at 10:56 am

Interesting concept. As a side note, several cardiologists with whom I am currently working have commented that these are not new guidelines, but rather more of a practice update. There is a ton of confusion in the field and the release of these, which appeared to be a haphazard attempt to appease the masses after the endless delay of ATP IV, has only made practice more challenging.

Aleta Kerrick

February 10, 2014 at 12:59 pm

I do like this visual. It’s easier to grasp than text which conveys the same info. But of equal, if not greater, interest would be a graphic showing the number of people who were ALIVE after 10 years. (Even better, alive with good quality of life.) After all, the real goal is not to avoid a heart attack but to live a longer, more enjoyable life.