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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