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Van de NHG-Standaard Cholesterol naar de NHG-Standaard Cardiovasculair risicomanagement: en nu?

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Huisarts en Wetenschap Aims and scope

Samenvatting

Scheltens T, Grobbee DE, Kok L, Verschuren WMM, Bots ML, Numans ME, Hoes AW. Van de NHG-Standaard Cholesterol naar de NHG-Standaard Cardiovasculair risicomanagement: en nu? Huisarts Wet 2008;51(9):420-5.

Doel In 2006 verving het NHG de uit 1999 stammende NHG-Standaard Cholesterol door de NHG-Standaard Cardiovasculair risicomanagement. De nieuwste standaard hanteert een andere risicofunctie en beveelt statinebehandeling aan vanaf een lager afkappunt van cardiovasculair risico. Wij onderzochten of behandeladviezen uit de oude standaard werden uitgevoerd en hoe het statinegebruik verandert als gevolg van de nieuwe standaard.

Methode De onderzoekspopulatie is afkomstig uit het Leidsche Rijn Gezondheidsproject en de Doetinchem Studie, waarin risicofactoren voor hart- en vaatziekten (HVZ) en medicatiegebruik zijn geregistreerd. Cardiovasculaire risico’s berekenden we met behulp van de Framingham- (1999) en de SCORE-risicofunctie (2006).

Resultaten Tweeënveertig procent (95%-BI 36-48) van de personen met een HVZ kreeg een behandeling. Van degenen zonder een HVZ, maar met een behandelindicatie kreeg 16% (95%-BI 10-22) een behandeling. Volgens de nieuwe standaard komen meer ouderen voor behandeling in aanmerking.

Conclusie In de onderzoeksperiode kregen weinig patiënten een behandeling met cholesterolverlagers conform de NHG-Standaard uit 1999. Als men de nieuwe standaard toepast, neemt het statinegebruik toe.

Abstract

Scheltens T, Grobbee DE, Kok L, Verschuren WMM, Bots ML, Numans ME, Hoes AW. From the NHG Cholesterol Standard to the NHG Cardiovascular Risk Management Standard: what happens now? Huisarts Wet 2008;51(9): 420-5.

Background Prevention of cardiovascular diseases (CVD) by detection and treatment of subjects at high risk for these diseases is the recommended strategy of the new Dutch guideline ‘Cardiovascular Risk management’, published in 2006. In comparison with the former guideline on cholesterol (1999), an other risk function was used and the cardiovascular risk thresholds for statin treatment were lowered. In this study, we described whether statin treatment was carried out according to the 1999 guideline for subjects with and without CVD. Furthermore, we presented the differences in eligible patients for statin treatment resulting from the former 1999 and the new 2006 guideline.

Methods Analyses were performed in a combined dataset of the Utrecht Health Project and the Doetinchem cohort. Of all participants cardiovascular risk factors and medical treatment was registered. Cardiovascular risks were calculated with the Framingham risk function (1999) and the SCORE risk function (2006).

Results Of all subjects with symptomatic CVD, 42% (95% CI 36-48) was treated. Of subjects free from CVD, yet with treatment indication according to their calculated risk, only 16% (95% CI 10-22) was actually treated. The new guideline assigned more subjects, mainly elderly, to treatment than the 1999 guideline.

Conclusions Few patients were treated with statins conform the former guideline. Implementation of the new guideline will enlarge the number of treated patients.

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Authors and Affiliations

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    Tjarda Scheltens

Authors
  1. Tjarda Scheltens
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  2. Rick Grobbee
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  3. Linda Kok
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  4. Monique Verschuren
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  5. Michiel Bots
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  6. Mattijs Numans
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  7. Arno Hoes
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Corresponding author

Correspondence to Tjarda Scheltens.

Additional information

Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, UMC Utrecht: T. Scheltens, huisarts; prof.dr. D.E. Grobbee, epidemioloog; dr. M.L. Bots, epidemioloog; dr. M.E. Numans, huisarts; prof.dr. A.W. Hoes, epidemioloog. RIVM, Bilthoven: dr. L. Kok, epidemioloog; dr. ir. W.M.M. Verschuren, epidemioloog.

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Financiële ondersteuning

Het Leidsche Rijn Gezondheidsproject wordt ondersteund door subsidies van het ministerie van Volksgezondheid, Welzijn en Sport, de universiteit van Utrecht, de provincie Utrecht, ZonMw, het UMC Utrecht en het College van Zorgverzekeringen.

De Doetinchem Cohort Studie werd financieel ondersteund door het ministerie van Volksgezondheid, Welzijn en Sport en het RIVM.

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Scheltens, T., Grobbee, R., Kok, L. et al. Van de NHG-Standaard Cholesterol naar de NHG-Standaard Cardiovasculair risicomanagement: en nu?. HUWE 51, 420–425 (2008). https://doi.org/10.1007/BF03086872

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