In Reply Dr Lloyd-Jones and colleagues clarify that the preferences of patients should be taken into account and that the guidelines on the use of statins should not be seen as mandates. However, given the credentials of the guideline panelists and the strong established tradition of the American College of Cardiology/American Heart Association (ACC/AHA) in generating highly influential guidelines, these documents end up being stronger than any absolute mandate. The intense conforming pressure that these guidelines exert on patients and clinicians1 cannot be underestimated.
Ioannidis JPA. Guidelines for Cardiovascular Risk Assessment and Cholesterol Treatment—Reply. JAMA. 2014;311(21):2235-2236. doi:10.1001/jama.2014.4075