The heart of effective CVD risk management

Abstract

Cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality in the UK, and this issue of Prescriber has three articles discussing approaches to managing this risk. On page 13, Simon Beggs and Roy Gardner discuss pharmacotherapy for the secondary prevention of myocardial infarction (MI). There are some really clear ‘key points’ provided for readers to take to their clinical practice regarding established therapies. The authors additionally highlight some of the newer innovations in post-MI cardiovascular risk management, that are perhaps less familiar to many working in primary care; for example, when to start a PCSK9 inhibitor for optimising lipid profile when statins aren't enough, and the role of mineralocorticoid blockade. The emerging, and as yet not fully understood, role of two of the newer antiglycaemic drug classes (SGLT2 inhibitors and GLP-1 receptor blockers) in preventing adverse cardiovascular outcomes is also discussed – probably coming to a NICE guideline near you in the near future. Away from the more traditional pharmacotherapies, David Laight reflects on the role of fish oils for CVD prevention (page 21). Is all that dietary advice about eating two portions of fish a week really justified? David discusses the pharmacological properties and evidence base underpinning these agents, and the future role of prescription omega-3 fatty acid derivatives alongside more established therapies. Talking of which, where would we be without mentioning statins? On page 34, Angus Thompson considers why these particular drugs seem to raise so many worries among patients and the wider public. The evidence certainly suggests these anxieties are unjustified, not just due to the benefits but also the lack of harms. A recent study in the BMJ that used a series of so-called ‘n-of-1’ trials – where individuals are switched between statin and placebo treatment in a random and blinded manner – found no evidence that statins caused muscle symptoms.1 For me, it speaks of the need for us to spend appropriate time with patients to check their understanding of proposed medicines, to address misconceptions and concerns, and to ensure patients are able to make appropriately informed decisions about their prescriptions.