This editorial refers to ‘Does implementation of the European guidelines based on the SCORE model double the number of Norwegian adults who need cardiovascular drugs for primary prevention? The Tromso study 2001'† by Hartz et al., on page 2673 Is the average elderly Norwegian at high risk of cardiovascular disease after 60 years of age? Will most of these men and women need health care or even drug treatment in order to lower serum lipids and/or blood pressure? Well, according to the present guidelines of the European Heart Association, this actually seems to be the case.1 Hartz et al .2 show that in Tromso, Norway, the vast majority of men >60 years, and females >70, have a 10-year risk of fatal cardiovascular disease exceeding 5%, the suggested limit for intervention. We can argue about the exact figures, including the (unpublished) confidence interval of the 5% limit, but the main message is clear: it is normal to be at ‘high’ risk. And what is true for Norway would be true for most other European countries. However, many clinicians will find this definition of normality hard to accept. Some will object simply on the basis of semantics: the ‘average’ can never be equal to ‘high’. Some will feel that it is unethical to turn the majority of seemingly healthy citizens into patients requiring medical treatment and surveillance. When it comes to long-term pharmacological treatment, many doctors are still wondering whether all-cause mortality is significantly lowered by drug treatment and whether study participants were representative of their own patients in clinical practice. Some will argue that the necessary societal expenses could be better used for other purposes, unless each person … *Corresponding author E-mail address : staffan.lindeberg{at}med.lu.se
Read full abstract