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From the cardiometabolic risk initiative

I gave a talk to the Alabama Primary Care Association on Lipid Management yesterday and was struck by several things. One was how lipids, along with everything else on the risk factor list (see figure) are affected by diet and exercise. Secondly, was how cardiovascular risk has been incorrectly sold to the American public and the health care enterprise. The National Heart Lung Blood Institute apparently decided that Americans were not going to be able to comprehend the concept of multi factorial risk. The simplistic version of “cholesterol” is 200 GOOD, 201 BAD. The more complex version takes into account smoking status, blood pressure, and sex. The cholesterol calculator then allows the “patient” to make a choice based on a risk determination. I find it to be a much better educational process for my patients and I hope I helped to increase the use of this tool. I was heartened that I was asked the question about “established standards” for review of care. We really are changing the way clinical care is delivered in the ambulatory setting.

  After spending time talking about pharmacologic interventions, I was not surprised to get the question regarding prophylactic use of “statins” in people who are low risk (< 10% mortality over 10 years). My answer surprised even me. As someone who doesn’t take pills, my response was that we as health care providers need to take advantage of the “teachable moment” not to encourage compliance with a potentially unnecessary medication but instead to encourage compliance and problem solve with patients about diet and physical activity. I answered that my response to my increased risk (due to impending “maturity”) was a daily run rather than a daily pill. Like to see Merk selling that, wouldn’t you?

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