Robert J. Glynn, PhD, ScD
Potential Conflicts of Interest: Dr. Glynn has received research support from AstraZeneca. The Brigham & Women's Hospital holds patents that relate to the use of inflammatory biomarkers in cardiovascular disease.
Glynn R.; The USPSTF Recommendation Statement on Coronary Heart Disease Risk Assessment. Ann Intern Med. 2010;152:403. doi: 10.7326/0003-4819-152-6-201003160-00015
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Published: Ann Intern Med. 2010;152(6):403.
TO THE EDITOR:
The statement from the U.S. Preventive Services Task Force (USPSTF) (1) that “persons with low (<10%) Framingham risk scores do not benefit from aggressive risk factor modification” and the conclusion that high-sensitivity C-reactive protein (CRP) does not improve a physician's ability to guide treatment do not reflect current randomized trial data. The USPSTF conclusions should be of particular concern for women, almost all of whom have Framingham risk scores less than 10%.
JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) (2) studied apparently healthy men and women with high-sensitivity CRP levels of 19 nmol/L or greater. The study group almost exclusively comprised persons with Framingham risk scores in the “intermediate” and “low” range who, under current guidelines, would not qualify for statin therapy because they also had low-density lipoprotein cholesterol levels less than 3.37 mmol/L (<130 mg/dL). Nonetheless, compared with placebo, allocation to rosuvastatin, 20 mg/d, resulted in a 44% reduction in the primary trial end point of major vascular events (P < 0.001), 54% reduction in myocardial infarction (P < 0.001), 48% reduction in stroke (P = 0.002), 46% reduction in the need for angioplasty or bypass surgery (P < 0.001), and 20% reduction in all-cause mortality (P = 0.021) (2). As reported in 2008 (2), these risk reductions were observed at all levels of Framingham risk.
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