June 23, 2005
Unease Over Guidelines that Label 9 Out of 10 People as Sick
Guidelines that set ever lower thresholds for "normal" blood pressure and cholesterol mean that 90% of people over 50 could be labelled as sick, warn doctors in this week's BMJ.
The latest European guidelines on prevention of cardiovascular disease suggest blood pressure above 140/90 mm Hg, with no age correction, and serum cholesterol of 5 mmol/l as the appropriate thresholds for being labelled at risk.
Although the guidelines recommend a range of lifestyle changes alongside drug treatment, the bottom line is that a disease label is to be attached to the patient, write Drs Steinar Westin and Iona Heath.
When researchers applied these guidelines to adults in Norway, they found that half the population would be considered at risk by the early age of 24 years, rising to 90% by the age of 49. As much as 76% of the total adult population would be considered at "increased risk."
These proportions are disturbingly high, and are likely to be even higher in other populations, such as the United Kingdom, say the authors.
They suggest that several issues need to be considered if such a large part of the population is to become a target for individual and lifelong risk interventions. For instance, the potential benefits for treated patients become less at lower risk levels, whereas the rates of side effects remain similar. Evidence for the long term effectiveness of treatment is also lacking.
Finally, the huge cost of drug treatment for an ever greater proportion of the population has the potential to destabilise publicly funded healthcare systems in even the richest nations, they warn.
"Such considerations are urgent as the guidelines from the European Society of Cardiology are in the process of being implemented and the quality and outcomes framework of the new general practitioner contract in the UK can be seen as part of this implementation," they conclude.
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